OnlineMedEd: Pulmonology - "COPD"

Question 1

The main gas problem in COPD is ____________.

Answer 1

CO2 trapping; oxygen does not usually change

Question 2

Because of ____________, those with COPD often get increased AP diameter.

Answer 2

chest wall hypertrophy due to increased work of exhalation

Question 3

Which patients typically have pulmonary hypertension, those with bronchitis or those with emphysema?

Answer 3

Bronchitis

Those with bronchitis are more likely to develop cyanosis (“blue bloaters”), and hypoxemia leads to vasoconstriction in the lungs.

Note: the reason they are referred to as “bloaters” is that those with bronchitis are more likely to get right-sided CHF and subsequent edema.

Question 4

The best diagnostic for COPD is _______________.

Answer 4

pulmonary function tests showing a decreased FEV/FVC ratio

Question 5

Go through the treatment guidelines for chronic COPD.

Answer 5

Like asthma, treatment for COPD goes up in stages and the treatment from the lower acuity stage is maintained:

1) SABA
2) SABA + LAMA
3) SABA + LAMA + LABA
4) SABA + LAMA + LABA + ICS
5) SABA + LAMA + LABA + ICS + PDE-4i
6) SABA + LAMA + LABA + ICS + PDE-4i + oral steroids

Question 6

Go through the mnemonic COPDER.

Answer 6

This is the treatment for chronic COPD:
•Corticosteroids: ICS, PO steroids, IV steroids
• Oxygen
• Prevention: smoking cessation; vaccines for flu and PNA
•Dilators: SABAs, LABAs, LAMAs, PDE-4is, orals (theophylline)
• Experimental: new stuff from pulmonologists, nothing to worry about as an MS3
• Rehab

Question 7

Give oxygen to those with COPD if ______________.

Answer 7

their SpO2 is less than 88% or their PaO2 is less than 55

Question 8

Why is the goal SpO2 88%-92%?

Answer 8

People normally have a hypercapnic respiratory drive (meaning elevated PCO2 stimulates breathing). Those with COPD have a chronically elevated PCO2 and thus lose that drive. Thus, they breathe when their oxygen levels drop. If you ventilate them for a long time and maintain their sats at near 100%, they will lose their respiratory drive and become difficult to wean from the ventilator.

Question 9

Acute COPD exacerbations should be treated with __________________.

Answer 9

antibiotics (doxycycline or azithromycin), bronchodilators (albuterol and ipratropium), and oral steroids (prednisolone as an outpatient or IV methylprednisolone as an inpatient)

Question 10

What does MDI stand for?

Answer 10

Metered-dose inhalers

Question 11

Go through the evaluation of acute COPD exacerbation.

Answer 11

Give them duonebs and oral steroids:
•If there SpO2 and clinical exam improve, send them home with MDIs and oral steroids.
• If they improve slightly but not dramatically, admit to the wards for PO steroids and nebulized bronchodilators.
• If they worsen (evidenced by rising PCO2, confusion, or decreased lung sounds), then admit to the ICU for IV steroids, nebulized bronchodilators, BiPAP, and ETT.