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
Multidrug resistant TB
resistant to both isoniazid and rifampin and possibly other agents
Extensively drug resistant TB
resistant to isoniazid, rifampin, fluoroquinolone and either aminoglucoside or capreomycin or both
Signs and Symptoms of TB
slowly progressive constitutional symptoms- malaise, anorexia, weight loss, fever, and night sweats. Chronic cough most common- dry at first but becomes productive of purulent sputum,
Lab Findings of TB
Cx- from 3 consecutive morning sputum, acid fast staining of sputum smear,
Nucleic acid amplification- detects & identifies resistance markers- allows for early isolation/treatment
Imaging for TB
pulmonary TB can not be distinguish btw primary and latent
Test for latent TB
Tuberculin skin test- transverse width in mm of induration measured in 48-72 hours
Interferon gamma release assays- no more sensitive that skin test
Treatment of Latent TB- 1 medication
Isoniazid- 9 month oral regimen preferable to 6 months, daily dose of 300mg or 2xWkly dose of 15mg/kg
supplement of B6 for high risk patient for neuropathy
Treatment for Latent TB 2 Medicaitons
Isoniazid/Rifampin- 3 month regimen daily (300/600)
Isoniazid/Rifampin- 3 month once weekly (15mg/kg & 15-30 mg/kg)
Tx for latent TB if intolerable to Isoniazid
Rifampin- 4 months daily at 400mg
Tx of HIV positive pt
Refer to HIV spec, need to be treated for 12 months
COPD Treatment
Bronchodilator- LABA/LAMA- LAMA- LAMA/LABA or ICS/LABA
Dyspnea with COPD
LABA or LAMA
then- LABA and LAMA or LABA and ICS then
LABA + LAMA + ICS
Consider switching inhaler device or investigate other causes
exacerbation w/COPD
LABA or LAMA then
LABA +LAMA or LABA + ICS then
LABA + LAMA + ICS then
Roflumilast or Zithromax- former smokers
SABA (short acting beta2 agonists
Fenoterol, Levalbuterol, Salbutamol, Terbutaline
LABA (Long acting Beta2 agonists)
Arformoterol, Formoterol, Indacaterol, olodaterol, salmeterol
SAMA (short acting anticholinergics)
Ipratropium bromide, oxitropium bromide
LAMA (long acting anticholinergics)
Aclidinium Bromide, Glycopyrronium bromide, Tiotropium, Umeclidnium, glycopyrrolate, revefenacin
Combination SABA and SAMA
Fentoterol/ipratropium
salbutamol/ipratropium
