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CDM 1 Exam 3 > Respiratory: COPD > Flashcards

Respiratory: COPD Flashcards

1
Q

Gas Exchange

A

Ability to transfer oxygen and carbon dioxide across alveoli membrane that is impaired in some cases of COPD

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2
Q

Alpha-1 Antitrypsin

A

An enzyme that regulates the breakdown of lung tissue

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3
Q

Emphysema

A

abnormal permanent enlargement of the airspaces distal to the terminal bronchioles accompanied by destruction of their walls yet without obvious fibrosis

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4
Q

Chronic Bronchitis

A

chronic or recurrent excessive mucus secretion into the bronchial tree with cough that is present on most days for at least 3 months of the year for at least 2 consecutive years in a patient in whom other causes of chronic cough have been excluded

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5
Q

COPD

A

a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gasses

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6
Q

COPD Risk factors

A

Exposure to particles (tobacco, ait pollution, dust/chemicals)

Genetic (a1 antitrypsin deficiency)
Age - elderly
Gender
Lung growth/development
Socioeconomic status
Asthma
Bronchial Hyper-reactivity
Chronic bronchitis
Infections
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7
Q

COPD Pathophysiology

A

inflammation due to Neutrophils*** macrophages, CD8 T cell (doesn’t respond well to ICS)

perpetual process of inflammation leading to damage and repair = associated w/ older age

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8
Q

2 aspects of COPD

A

Small airway disease
&
Parenchymal destruction

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9
Q

Air trapping means that you’ll have….

A

more volume left in lungs after breath

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10
Q

Somethings seen with COPD

A

Air trapping
Gas exchange abnormalities
Mucus hypersecretion
Systemic manifestations

“barrel lung” and flattening of diaphragm due to air trapping

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11
Q

COPD Presentation

A 
Dyspnea
Cough
Sputum production
Wheezing and chest tightness
* often have for years preceding diagnosis*
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12
Q

Pts >40 yrs old with at least one of these should be assessed for COPD

A 
Dyspnea
Chronic Cough
Chronic Sputum Production
Recurrent lower respiratory tract infection
History of exposure to risk factors
FH of COPD and/or childhood factors
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13
Q

Spirometry value for COPD diagnosis

A

post-bronchodilator FEV1/FVC <70%

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14
Q

Gold 1

A

Mild

FEV >80% predicted

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15
Q

Gold 2

A

Moderate

FEV 50-80% predicted

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16
Q

Gold 3

A

Severe

FEV 30-50% predicted

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17
Q

Gold 4

A

Very Severe

FEV 30% predicted

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18
Q

Objective measure of COPD

A

FEV1/FVC <70%

FEV1 predicted to determine Gold 1-4

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19
Q

Other objective measures of COPD

A

Imaging (CXR, CT)
Lung volumes and diffusing capacity
Oximetry and arterial blood gas
Exercise testing and assessment of physical activity

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20
Q

Low risk of exacerbations

A

< 1 exacerbations per year, and no hospitalization for exacerbation

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21
Q

High risk of exacerbations

A

> 2 exacerbations per year, or > 1 hospitalization

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22
Q

1st line therapy for COPD

A

Bronchodilator due to COPD being different kind of therapy

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23
Q

Anti-inflammatory agents are ____ to COPD

A

Add ons, usually to bronchodilators

ex.
Corticosteroids
PDE 4 Inhib
Macrolides

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24
Q

Goals of COPD Management?

A

Reduce Symtoms (receive symptoms, improve exercise tolerance & health status)

Reduce risk (prevent progression, exacerbations, reduce mortality)

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25
Q

Bronchodilator meds for COPD

A

B2 agonist
Anticholinergic
Methylxanthines

26
Q

Anti inflammatory Medications for COPD

A

PDE4 inhib
Corticosteroids
Macrolides

27
Q

Combo Therapies for COPD

A

Anticholinergic + B2 agonist
ICS/LABA
ICA/LABA/LAMA

28
Q

SABA for COPD

A

Albuterol & Levalbuterol

PRN for SOB, can see combo with ipratropium for maintenance therapy

29
Q

Tiotropium V Salmeterol

A

Tiotropium = more effective than salmeterol in preventing exacerbations.

Used daily, longer time to 1st exacerbation

30
Q

Tiotropium v ICS/LABA

A

no difference in exacerbation rate between both groups

31
Q

Clinical benefits of LAMA (Tiotropium)

A

Improvements in Health status, symptoms, FEV1, Effectiveness of pulmonary rehabilitation**, improved exercise performance

Improvements in exacerbation risk (better than LABA) and hospitalization rates

32
Q

Methylxanthines (Theophylline) for COPD

A

less effective and no preffered

used as alternative treatment option

33
Q

Key points for Bronchodilators COPD

A
  1. Inhaled bronchodilators are backbone of COPD therapy
  2. LAMAs> LABAs for exacerbation/hospitalization rate reduction
  3. Theophylline not recommended unless other bronchodilator unavailable or too much $$
  4. LA>SA and Inhaled>PO therapy
  5. Combo therapy better than mono
  6. pts can start on 1/2 bronchodilators or escalate from 1 to 2
34
Q

When to not use ICS with COPD

A

Repeated pneumonia events
Blood eosinophils <100 cells/mcL
History of mycobacterial infection

35
Q

When to consider use of ICS with COPD

A

1 moderate exacerbation of COPD per year

Blood eosinophils 100-300 cell/mcL

36
Q

When strong support for ICS with COPD

A

History of hospitalizations for exacerbations of COPD
>2 moderate exacerbations of COPD per year
Blood eosinophils > 300 cells/mcL
History of, or concomitant, asthma

37
Q

Who should not get Roflumilast for COPD?

A 
HIV patients (protease inducers)
Those who have depression or anxiety
38
Q

Indication for Roflumilast in COPD?

A

FEV <50% and chronic bronchitis with repeat exacerbations

39
Q

Indication for Azithromycin in COPD?

A

Former smokers with repeat exacerbations

40
Q

Clinical benefits of Macrolide antibiotics?

A

Long term use of Azithromycin and erythromycin reduce exacerbation rates

41
Q

Key points for anti-inflammatory agents in COPD?

A
  1. ICS + LABA maybe considered in pt with exacerbations despite being on appropriate treatment with LABA
  2. In pt w/ exacerbations despite LABA +/- ICS, w/ chronic bronchitis and FEV <50%…consider PDE4 inhibitor
  3. Monotherapy with ICS or Oral Steroid = not recommended
42
Q

Vaccinations recommended in COPD

A

Flu
Penuomococcal
Tdap

43
Q

Alpha-1 Antitrypsin Replacement therapy is used in patients with…

A

alpha-1 antitrypsin deficiency

44
Q

Non-pharmacologic treatment Options for COPD

A 
Risk factor avoidance (#1 = stop smoking)
Long-term oxygen therapy (15hr< day)
Ventilatory Support
Surgery
Palliative Care
Pulmonary Rehab
Physical Activity
Education
45
Q

What is pulmonary Rehab

A

training program, usually about 6 weeks

exercise training, smoking cessation help, education, nutrition counseling

46
Q

Patient Group A recommendations

A

Essential: stop smoking

Recommended: Physical activity

Depend on guidelines:
Flu, Pneumococcal, Tdap, COVID-19, Zoster pt >50

47
Q

Patient Group B,C,D recommendations

A

Essential: Stop smoking, Pulmonary Rehab

Recommended: Physical Activity

Depend on guidelines:
Flu, Pneumococcal, Tdap, COVID-19, Zoster pt >50

48
Q

Initial Therapy: Group C

A

LAMA

49
Q

Initial Therapy: Group D

A

LAMA
LAMA/LABA ( CAT >20)
ICS/LABA (eon > 300)

50
Q

Initial Therapy: Group A

A

A bronchodilator

51
Q

Initial Therapy: Group B

A

LAMA or LABA

52
Q

Monitoring and Follow-up COPD

A

Symptoms = at each visit
Exacerbations = at each visit
Spirometry = at diagnosis + yearly
Risk factors, meds, comorbid conditions

53
Q

COPD Comorbid conditions

A 
CVD
Osteoporosis
Anxiety/Depression
Lung cancer
Sleep Apnea
GERD
Bronchiectasis
Metabolic Syndrome & Diabetes (usually need to give extra insulin w/ pt on steroids)
54
Q

Can you use beta blockers in patients with CVD and COPD

A

Yes, since it helps with mortality benefit.

Friends don’t let Friends use atenolol

55
Q

Mild COPD Exacerbation

A

Treated with a short acting bronchodilator only

56
Q

Moderate COPD Exacerbation

A

Treated with Short acting Bronchodilators + antibiotics +/- oral corticosteroids

57
Q

Sever COPD Exacerbation

A

require hospitalization or visit to ER

58
Q

Cause of acute exacerbation of COPD

A

Infection (Big reason, #1)
Air pollution
Allergy
Unknown

59
Q

Cardinal Symptoms for in COPD exacerbations

A

Increased Breathlessness
Increased Sputum Volume
Increase in Sputum Purulence

60
Q

Who gets Antibiotics in COPD Exacerbation?

A

3 cardinal Symptoms

2 cardinal Symptoms (if Sputum purulence is 1 of them)

Severe exacerbation that require mechanical ventilation

61
Q

Summary for COPD Exacerbations

A

SABA/SAMA = increased dose/frequency
Corticosteroids = 40mg prednisone X 5 days
Antibiotics 5-7 days if meet criteria

CDM 1 Exam 3 (10 decks)

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