Pulm: COPD Flashcards
This condition is characterized by persistent respiratory sxs and airflow limitation
COPD
Small airway disease in COPD is characterized by what two pathyphysiologic responses?
airway inflammation and remodeling
Parenchymal destruction in COPD is characterized by what two pathophysiologic responses?
loss of alveolar attachments
decreased elastic recoil
Chronic bronchitis is characterized by presence of productive cough for…
at least 3 months in two consecutive years
This is the destruction of gas-exchanging surfaces of the lung (alveoli)…
emphysema
The following systemic effects are indicative of what pulm. disorder?
hypoxemia, hypercapnea respiratory acidosis cyanosis cor pulmonale weight gain/loss
COPD
A patient presents with the following:
5th or 6th decade of life
DOE
Chronic cough
Sputum production
Recurrent lower respiratory infx
What is this concerning for?
COPD
What is a major risk factor for COPD?
tobacco smoke
What are the three “host factors” that contribute risk for COPD?
Alpha-1 antitrypsin deficiency
asthma
hx childhood respiratory infx
Smoking stimulates elastase enzymes in the lungs. What two actions do elastases undergo?
degenerate elastin
release oxygen radicals from WBCs
This disorder that accounts for < 1% of COPD has the following characteristics:
- causes premature emphysema
- causes overstimulation of proteases due to deficiency
- lung destruction accelerated with this disease and smoking
alpha-1 antitrypsin deficiency
What are the three hallmark sxs of COPD?
Dyspnea
Chronic Cough
Sputum production
What can be found on physical exam of a patient with COPD? (4)
use of accessory mm, tripoding
pursed lip breathing
cor pulmonale
digital clubbing
Why does pursed lip breathing help in COPD?
prevents early bronchial collapse by increasing bronchial pressure
What is the most common cause of cor pulmonale? (RHF)
COPD
Patient presents with COPD and the following:
S3 gallop
RVH
Hepatomegaly
Peripheral Edema
What should you be suspicious for?
cor pulmonale
A COPD patient arrives to the clinic with the following:
increased dyspnea
increased cough frequency/severity
increased/purulent sputum
What might be going on?
acute exacerbation of COPD
What diagnostic is required to establish a COPD diagnosis?
Spirometry
In addition to spirometry, what labs/diagnostics/imaging may be helpful? (5)
pulse ox
ABGs
CBC, BNP, cardiac enzymes, CMP, AAT
sputum culture
CXR/HRCT
What test is used to diagnose and determine severity of COPD?
spirometry
A post-bronchodilator FEV-1/FVC ratio of _______ confirms an obstructive pattern?
< 0.7
Which GOLD class?
FEV-1 80+% of predicted
mild, class I
Which GOLD class?
FEV-1 50-80% of predicted
Moderate, Class II
Which GOLD class?
FEV-1 30-49% of predicted
Severe, Class III
Which GOLD class?
FEV-1 < 30% of predicted
Very Severe, IV
What diagnostic should be ordered in the following conditions?
FEV-1 < 50
SpO2 < 92
Depressed LOC
Acute Exacerbation
ABGs
What diagnostic should be ordered in a patient in the following conditions?
pt. < 45yo
non-smoker
FHx of emphysema
AAT
Is a CBC usually altered in COPD?
no, usually normal
What CXR finding is pathognomonic for emphysema?
blebs or bullae
What three signs on CXR indicate air trapping in COPD?
Increased AP diameter
Hyperinflation and hyperlucency
flattened diaphragms
What may be present on CXR in chronic bronchitis?
perivascular/peribronchial markings
What imaging modality can be considered when the following are present?
pneumonia, PTX, large bullae
PE
Considering lung resection
CT Chest
What intervention is key to preventing COPD progression?
smoking cessation
3 minutes of counselling can increase smoking quit rate by___
5-10%
What vaccines should be considered for COPD?
influenza
pneumococcal
O2 administration for ________ daily is shown to increase survival in patients with SpO2 of…
15+ hours daily
SpO2 < 88, PaO2 < 56
Grade A COPD is treated with…
SABA PRN
Grade B COPD is treated with…
SABA + LAMA or LABA
Grade C COPD is treated with…
SABA + LAMA
Grade D COPD is treated with…
SABA + LAMA or LABA-LAMA
What is the normal SABA (albuterol) dose?
2 puffs q 4-6 hours PRN
Salmeterol and formoterol are…
LABA
Ipratropium is a…
short acting anticholinergic
Tiotropium and umeclidinium are what class of drug?
Long acting anticholinergics
Fluticasone-salmeterol
Budesonide-formoterol
These are examples of…
LABA-ICS
for whom is antiprotease therapy indicated?
AAT deficiency
What are the two most common triggers for an acute exacerbation of COPD?
viral respiratory illness and pollution
How is an acute COPD exacerbation managed in an outpatient setting?
Increase SABA
Prednisone 40mg QD x 5 days
What can be added for moderate to severe exacerbations of COPD?
abx x 5-7 days
