Module 3- COPD/TB Flashcards
COPD
Common, treatable, preventable
clinical syndrome of chronic respiratory symptoms, structural pulmonary abnormalities, impaired lung function arising from multiple causes that result in airflow limitation that is not fully reversible
Causes of COPD
Smoking and biomass fuel cooking
hereditary factors- alpha I antiprotease
Symptoms and Sign of COPD
normally 5th or 6th decade of life
excessive cough, sputum productive and shortness of breath
if dx early absence of smoking will reduce decline in lung function
Dyspnea is mild on exertion at the start but in severe disease dyspnea occur at rest
Pink puffers vs blue bloaters
Exacerbations of COPD
commonly precipitated by infection or environmental factors
Prevention of COPD
preventable through elimination of longterm exposure to tobacco, products of combustion of biomass fuels, and other inhaled toxins
High Risk indicators of COPD
FEV1 less than 50% of predicted
two or more exacerbations within pervious year
one or more hospitalizations for COPD exacerbations in the pervious year
Smoking cession
single most important intervention
Oxygen Therpay
for resting hypoxemia- PaC02 < 56mm hg
include longer survival, reduced hospitalizations and better quality of life
inhaled bronchodilators
do not alter decline in lung function
SAMA 1st line due to longer duration of action
SABA offer more rapid onset but more side effects
does not improve dyspnea
LAMA- 1st line in mild disease- more severe LAMA/LABA initated
Corticosteroids
ICS- not first line but can be added to LABA
if stable for 2 years remove ICS
No oral steroid unless acute exacerbation present
Theophylline
4th line defense- improves dyspnea, exercise and pulmonary function, benefits are from bronchodilation, anti-inflammatory properties and extra-pulmonary effects
toxicity concerns
Last resort
Antibiotics of COPD
Treat acute exacerbation, to treat acute bronchitis and prevent acute exacerbation of chronic bronchitis
Increased sputum will benefit from abx
Abx choices for COPD
Treat pseudomonas aeruginosa
doxy, trimethoprim, cephalosporin, macrolide, fluoroquinolone, augmentin
3-5 days
Pulmonary rehabilitation
graded aerobic physical exercise programs
phosphodiesterase 4 inhibitor
Rofumilast- reduce exacerbation frequently
Procedures for COPD
lung transplant
lung volume reduction surgery
bullectomy
When to refer for COPD
COPD before age 40, frequent excerbautions, severe or rapid disease, need for long-term o2, disproportionate symptoms, onset of comorbid illness
When to admit for COPD
severe symptoms, acute hypoxemia/hypercapnia/peripheral edema/change in mental status
Pulmonary tuberculosis
causes by M. tuberculosis
Transmitted by inhaled airborne droplet nuclei containing viable organisms
Risk Factors of TB
disadvantage populations
malnourished, homeless, overcrowded and substandard housing, HIV
Primary TB
clinically and radiographically silent, most people with intact T cell medicated responses limit multiplication and spread but doesn’t eradicated disease but lies dormant
Latent TB infection
do not have an active disease and cannot transmit the organism to others, but reactivation of disease may occur if immune defense are impaired
Active TB
5-15% of individuals with latent TB who are not give preventive therapy,
Drug resistant TB
resistant to one of the first line drugs, either isoniazid or rifampin
