Respi-COPD Flashcards
What is COPD?
A heterogenous lung condition characterized by chronic respiratory symptoms
List the chronic respiratory symptoms associated with the condition defined in the GOLD 2025 report.
- Dyspnea (progressive, worse with exercise, persistent)
- Cough (may be intermittent and non-productive)
- Sputum production
- Exacerbations
What causes the chronic respiratory symptoms outlined in the GOLD 2025 report?
Abnormalities of airways and/or alveoli
Name the types of abnormalities mentioned in the GOLD 2025 report.
- Bronchitis
- Emphysema
What is a key feature of the condition described in the GOLD 2025 report?
Persistent, progressive airflow obstruction
What are the primary causes and risk factors for the condition according to the GOLD 2025 report?
Smoking and inhalation of toxic particles and gas
What are the diagnostic criteria for the condition as per the GOLD 2025 report?
Appropriate clinical context and presence of non-fully reversible airflow obstruction (FEV1/FVC < 0.7 post-bronchodilation) measured by spirometry
What is defined as Pre-COPD in the GOLD 2025 report?
Physiological abnormalities or structural lung lesions without airflow obstruction (FEV1/FVC >= 0.7) post-bronchodilation
What does PRISm stand for?
Preserved Ratio Impaired Spirometry
What is the spirometric criterion for airflow obstruction selected by GOLD for the diagnosis of COPD?
A post-bronchodilator ratio of FEV1/FVC < 0.7
What initial assessments are suggested in the GOLD 2025 report?
- Severity of airflow obstruction
- Nature and magnitude of current symptoms
- Previous history of moderate and severe exacerbations
- Blood eosinophil count
- Presence and type of other diseases (multimorbidity)
What is recommended for immediate relief of symptoms according to the GOLD 2025 report?
Rescue SABA
What should be considered if dyspnea persists on monotherapy bronchodilator?
Use 2 long-acting bronchodilators, if oes>=100, add ICS. If eos>=300, add Dupilumab (immunologic)
What is indicated for stable patients with specific PaO2 or SaO2 levels?
LT02
What PaO2 levels indicate the need for LT02 according to the GOLD report?
- PaO2 <= 55 mmHg or SaO2 <= 88% with or without hypercapnia confirmed 2x over a 3-week period
- PaO2 55-60 mmHg or SaO2 of 88% if evidence of pulmonary HTN, peripheral edema suggesting CCG, or polycythemia (hematocrit > 55%)
What should be done to ensure proper oxygen therapy as per the GOLD 2025 report?
Titrate to sPO2 >= 90%
How often should patients be re-evaluated after starting LT02?
60-90 days with ABD or O2 sats while inspiring RA
What is the pathophysiology of COPD?
Chronic inflammation → Small airway narrowing & mucus hypersecretion
Alveolar destruction (emphysema) → ↓ Elastic recoil & air trapping
Mucociliary dysfunction → Impaired clearance of mucus & pathogens
Airflow limitation → Progressive and irreversible obstruction
What are the clinical features of COPD?
- Chronic cough (often productive in chronic bronchitis)
- Dyspnea (progressive, worse with exertion)
- Wheezing & prolonged expiratory phase
- Barrel chest (in emphysema due to hyperinflation)
- Pursed-lip breathing & accessory muscle use
What are some relevant tests done for COPD?
- Spirometry (GOLD standard):
FEV1/FVC < 70% (persistent airflow limitation)
↓ FEV1 (severity grading) - Chest X-ray: Hyperinflation, flat diaphragm (emphysema)
- CT scan: Better detection of emphysema
- ABG (in severe cases): Chronic respiratory acidosis
How is COPD severity classified (GOLD criteria)?
Based on FEV1 % predicted:
Mild (GOLD 1): FEV1 ≥80%
Moderate (GOLD 2): 50% ≤ FEV1 <80%
Severe (GOLD 3): 30% ≤ FEV1 <50%
Very severe (GOLD 4): FEV1 <30%
What are the signs of a COPD exacerbation?
Increased dyspnea, cough, and sputum production
Worsening hypoxia (cyanosis, confusion)
Use of accessory muscles, paradoxical breathing
Possible wheezing or silent chest (severe case)
How are COPD exacerbations managed?
- Oxygen therapy (target SpO2 88-92%)
- Short-acting bronchodilators (SABA + SAMA)
- Systemic corticosteroids (Prednisone 40 mg x 5 days)
- Antibiotics (if increased sputum purulence or infection suspected)
- Non-invasive ventilation (BiPAP) if respiratory failure develops
What defines an acute exacerbation of COPD (AECOPD)?
Increased dyspnea and/or cough and sputum worsening in <14 days
