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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
Bronchodilator meds for COPD
B2 agonist Anticholinergic Methylxanthines
26
Anti inflammatory Medications for COPD
PDE4 inhib Corticosteroids Macrolides
27
Combo Therapies for COPD
Anticholinergic + B2 agonist ICS/LABA ICA/LABA/LAMA
28
SABA for COPD
*Albuterol* & Levalbuterol PRN for SOB, can see combo with ipratropium for maintenance therapy
29
Tiotropium V Salmeterol
Tiotropium = more effective than salmeterol in preventing exacerbations. Used daily, longer time to 1st exacerbation
30
Tiotropium v ICS/LABA
no difference in exacerbation rate between both groups
31
Clinical benefits of LAMA (Tiotropium)
Improvements in Health status, symptoms, FEV1, Effectiveness of pulmonary rehabilitation**, improved exercise performance Improvements in exacerbation risk (better than LABA) and hospitalization rates
32
Methylxanthines (Theophylline) for COPD
less effective and no preffered used as alternative treatment option
33
Key points for Bronchodilators COPD
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
When to not use ICS with COPD
Repeated pneumonia events Blood eosinophils <100 cells/mcL History of mycobacterial infection
35
When to consider use of ICS with COPD
1 moderate exacerbation of COPD per year | Blood eosinophils 100-300 cell/mcL
36
When strong support for ICS with COPD
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
Who should not get Roflumilast for COPD?
``` HIV patients (protease inducers) Those who have depression or anxiety ```
38
Indication for Roflumilast in COPD?
FEV <50% and chronic bronchitis with repeat exacerbations
39
Indication for Azithromycin in COPD?
Former smokers with repeat exacerbations
40
Clinical benefits of Macrolide antibiotics?
Long term use of Azithromycin and erythromycin reduce exacerbation rates
41
Key points for anti-inflammatory agents in COPD?
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
Vaccinations recommended in COPD
Flu Penuomococcal Tdap
43
Alpha-1 Antitrypsin Replacement therapy is used in patients with...
alpha-1 antitrypsin deficiency
44
Non-pharmacologic treatment Options for COPD
``` Risk factor avoidance (#1 = stop smoking) Long-term oxygen therapy (15hr< day) Ventilatory Support Surgery Palliative Care Pulmonary Rehab Physical Activity Education ```
45
What is pulmonary Rehab
training program, usually about 6 weeks exercise training, smoking cessation help, education, nutrition counseling
46
Patient Group A recommendations
Essential: stop smoking Recommended: Physical activity Depend on guidelines: Flu, Pneumococcal, Tdap, COVID-19, Zoster pt >50
47
Patient Group B,C,D recommendations
Essential: Stop smoking, Pulmonary Rehab Recommended: Physical Activity Depend on guidelines: Flu, Pneumococcal, Tdap, COVID-19, Zoster pt >50
48
Initial Therapy: Group C
LAMA
49
Initial Therapy: Group D
LAMA LAMA/LABA ( CAT >20) ICS/LABA (eon > 300)
50
Initial Therapy: Group A
A bronchodilator
51
Initial Therapy: Group B
LAMA or LABA
52
Monitoring and Follow-up COPD
Symptoms = at each visit Exacerbations = at each visit Spirometry = at diagnosis + yearly Risk factors, meds, comorbid conditions
53
COPD Comorbid conditions
``` CVD Osteoporosis Anxiety/Depression Lung cancer Sleep Apnea GERD Bronchiectasis Metabolic Syndrome & Diabetes (usually need to give extra insulin w/ pt on steroids) ```
54
Can you use beta blockers in patients with CVD and COPD
Yes, since it helps with mortality benefit. Friends don't let Friends use atenolol
55
Mild COPD Exacerbation
Treated with a short acting bronchodilator only
56
Moderate COPD Exacerbation
Treated with Short acting Bronchodilators + antibiotics +/- oral corticosteroids
57
Sever COPD Exacerbation
require hospitalization or visit to ER
58
Cause of acute exacerbation of COPD
Infection (Big reason, #1) Air pollution Allergy Unknown
59
Cardinal Symptoms for in COPD exacerbations
Increased Breathlessness Increased Sputum Volume Increase in Sputum Purulence
60
Who gets Antibiotics in COPD Exacerbation?
3 cardinal Symptoms 2 cardinal Symptoms (if Sputum purulence is 1 of them) Severe exacerbation that require mechanical ventilation
61
Summary for COPD Exacerbations
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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