Obstructive Lung Disease Flashcards
2 main conditions included in designation of COPD
Chronic bronchitis [productive cough x3 months in each of 2 successive years]
Emphysema [permanent enlargement of airspaces distal to terminal bronchioles with destruction of bronchiolar walls]
Reasons for dyspnea in COPD
Increased dead space — increases PaCO2
Altered V/Q relationships — hypoxemia
Airflow obstruction — limits ability to meet increased demands
Reduced mechanical advantage of the diaphragm [Hoover sign, accessory respiratory muscle use, paradoxical respiratory motion]
Common causes of COPD
AAT deficiency [causes panacinar emphysema]
Cigarette smoking
Other environmental exposures: occupational dust, chemical agents, air pollution (including smoke from indoor burning of biomass fuels — often seen in other countries)
Developmental risk factors like low birth weight and childhood illness
COPD is confirmed and staged with ______
Spirometry
The presence of a postbronchodilator FEV1 that is ____ of predicted, and an FEV1:FVC ratio ______ confirms the presence of a nonreversible airflow obstruction
<80%; <70%
GOLD Criteria: Stage I characteristics and Tx
FEV1/FVC <70%
FEV1 >80% of predicted
With or without chronic symptoms (cough, sputum production)
Tx: Either SABA or SAMA prn; often orered together as Combivent
[Stage I = Mild]
GOLD Criteria: Stage II characteristics and Tx
FEV1/FVC <70%
FEV1 = 50-80% of predicted
With or without chronic symptoms (cough, sputum production)
Tx: Regular tx with LABA or LAMA; add pulmonary rehab
[Stage II = Moderate]
GOLD Criteria: Stage III characteristics and Tx
FEV1/FVC <70%
FEV1 = 30-50% of predicted
With or without chronic symptoms (cough, sputum production)
Tx:
ICS + LABA — or — ICS + LAMA
[with or without either roflumilast or theophylline]
[Stage III = Severe]
GOLD Criteria: Stage IV characteristics and Tx
FEV1/FVC <70%
FEV1 <30% of predicted OR FEV1 <50% of predicted plus chronic respiratory failure
Tx: [ICS + LABA] or [ICS + LAMA] or [ICS + LAMA + LABA]
With or without either roflumilast or theophylline; add long-term O2 therapy if chronic respiratory failure
[Stage IV = very severe]
In general, treatment of COPD is based on results of _____
PFTs
NEVER use ____ alone as tx for COPD
ICS
The MRC dyspnea scale helps the clinician to objectify the degree of dyspnea, and it can be used to measure the benefit of therapy longitudinally. What is the dyspnea scale?
Grade 1: not troubled by breathlessness except on strenuous exercise
Grade 2: short of breath when hurrying on level ground, or walking up a slight hill
Grade 3: walks slower than most people on that level, stops after a mile or so, or stops after 15 minutes of walking at own pace
Grade 4: stops for a breath after walking about 100 yards or after a few minutes on level ground
Grade 5: too breathless to leave the house, or breathless while dressing
3 types of bronchodilators used in stable COPD
Beta-agonists
Anticholinergic agents
Theophylline
Nonpharmacologic interventions for COPD
Pulmonary rehab
Percussion, vibration, and postural drainage to enhance sputum clearance
Relaxation techniques to reduce anxiety d/t dyspnea
Control of breathing, pursed-lip breathing, and diaphragmatic breathing to alleviate dyspnea
OMM
All patients who have unexplained dyspnea and cough should be evaluated for _______
AAT deficiency
