Pulmonology #1 (COPD, CF) Flashcards
What is COPD?
Largely irreversible airflow obstruction due to 1) loss of elastic recoil and 2) increased airway resistance.
What are risk factors associated with COPD?
(Most important): cigarette smoking/exposure
-Alpha-1-antitrypsin deficiency
-Occupational/environment exposure
-Recurrent airway infections
What is the only genetic disease linked to COPD in younger patients (<40)
Alpha-1-antitrypsin deficiency
Emphysema, defined as ________, has a risk factor of _____ as being the most important
Permanent enlargement of the terminal airspaces
Smoking
Explain the pathophysiology of emphysema
-Chronic inflammation leads to decreased protective enzymes and increased damaging enzymes
-Alveolar capillary destruction and alveolar wall destruction
-Loss of elastic recoil and increased compliance leads to airway obstruction
Explain the location of emphysema in the lungs if the patient is a smoker vs alpha-1-antitrypsin deficient
Smoker: Centrilobar (proximal acinar)
Alpha-1: Panacinar (diffuse)
Symptoms and exam findings of a patient with emphysema
-Dyspnea (hallmark)
-Chronic cough
-Decreased breath sounds
-increased AP diameter (barrel chest)
-hyperresonance to percussion
-wheezing
-Non-cyanotic: pink puffers
-Pursed lip expiration
-Tripod positioning to improve breathing
What is the gold standard diagnostic for emphysema? What does it show?
Pulmonary function test
Decreased FEV1, decreased FEV1/FVC < 70% (obstructive pattern), decreased DLCO
What does a chest radiograph for a patient with emphysema show?
Hyperinflation
Flattened diaphragms
Increased AP diameter
Decreased vascular markings
Bullae
What is chronic bronchitis defined as?
Productive cough for at least 3 months a year for 2 consecutive years
MC etiology of chronic bronchitis
SMOKING
What is the pathophysiology of chronic bronchitis?
-Chronic inflammation leads to mucous gland hyperplasia, goblet cell mucus production, dysfunctional cilia, and infiltration of neutrophils and CD8+ cells
-This leads to increased infections
What are the three cardinal symptoms of chronic bronchitis?
-Chronic cough
-Sputum production
-Dyspnea
What is on physical exam in a patient with chronic bronchitis?
-Crackles (rales)
-Rhonchi
-Wheezing
-Signs of cor pulmonale (enlarged liver, JVD, and peripheral edema)
-Cyanosis and obesity (blue bloaters)
What is the gold standard diagnostic for chronic bronchitis?
PFT shows obstructive pattern
What is the ONE difference in the PFT pattern in chronic bronchitis vs emphysema?
In emphysema, DLCO is decreased
In chronic bronchitis, it is normal.
What is DCLO?
Diffusing Capacity of the Lungs
What is seen on ECG in a patient with chronic bronchitis?
Cor pulmonale (RVH, atrial enlargement, right axis deviation)
What other labs are drawn if chronic bronchitis is suspected?
CBC: increased hemoglobin and hematocrit
ABG: respiratory acidosis (hypercapnia)
Most important set in management of COPD to reduce mortality
Smoking cessation
What are two GENERAL steps in management of a patient with COPD?
Oxygen therapy: if paO2 < 55 mmHg or saturation less than 88%
Pneumococcal vaccinations and annual influenza vaccinations
What ABX are used for acute exacerbations of chronic bronchitis?
-Macrolides (Azithromycin, Clarithromycin)
-Cephalosporins
-Augmentin
-Fluoroquinolones
What is the treatment for COPD (based on Categories A-D)
SABA or SAMA
Then combination of both
LAMA or LABA added to short-acting
LAMA may be better than LABA
LAMA
LAMA + LABA is better though
LAMA + LABA + inhaled glucocorticoid if persistent symptoms
What are three indications of oxygen therapy in COPD?
-Cor pulmonale
-O2 saturation < 88%
-PaO2 < 55 mmHg
What is one SABA and what are some adverse reactions?
Albuterol
Tachycardia, palpitations, tremors
What is one SAMA and what are some adverse effects?
Ipratropium
Anticholinergic: dry mouth, thirst, blurred vision, urinary retention, difficulty swallowing
What are some LABAs?
Salmeterol
Formoterol
Name one LAMA
Tiotropium
What is one adverse reaction to the inhaled glucocorticoid, fluticasone?
Oral candidiasis
What gene pattern is cystic fibrosis?
Autosomal recessive
Cystic fibrosis is MC in what populations?
Caucasians and Northern Europeans
What’s the pathophysiology of cystic fibrosis?
-Mutation in CTFR gene leads to abnormal chloride and water transport across exocrine glands leading to thick, viscous secretions of the lungs, pancreas, sinuses, and GU tract
What are some symptoms of CF?
-Infants: meconium ileus, failure to thrive, diarrhea
-Pulmonary: MCC of bronchiectasis
GI: malabsorption of vitamins ADEK, diarrhea, recurrent pancreatitis
-Infertility
What is the MOST accurate diagnostic for CF?
Sweat chloride elevation (60 mmol/L or greater on two occasions after Pilocarpine administration)
What does Pilocarpine do to help the sweat chloride test?
Induces sweating
What is seen on a PFT in cystic fibrosis?
Obstructive pattern
ABX are often needed in CF. What are some that are commonly used?
-macrolides (Azith, Clarith)
-Cephalosporins
-Augmentin
-Fluoroquinolones
What are other treatment recommendations for CF?
-Airway clearance treatment: inhaled bronchodilators, decongestants
-Supportive: ADEK supplementation, vaccinations (Pneumo, Influenza)
