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General Medicine & Family Medicine > Respiratory & Sleep Medicine\ COPD > Flashcards

Respiratory & Sleep Medicine\ COPD Flashcards

1
Q

What is COPD?

A

A chronic lung disease characterised by airflow limitation caused by airway (inflammation, increased mucous) and parenchymal destruction

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2
Q

What is the strongest risk factor associated with the development of COPD?

A

Smoking

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3
Q

Does COPD worsen over time?

A

Yes, unlike asthma, COPD tends to be a progressive disease, especially if exposure to harmful substances usually smoking continues.

Reduction or elimination of exposures can significantly reduce the rate of lung function deterioration.

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4
Q

What are the two types of COPD?

A

Chronic bronchitis and emphysema

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5
Q

What is chronic bronchitis?

A
  • Chronic bronchitis is a chronic expiratory airflow obstruction with a cough, and excessive sputum production for at least three months in a year for two years.
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6
Q

What is emphysema?

A
  • emphysema is chronic expiratory airflow obstructionwith enlargement of the airways, destruction of the alveoli and loss of elasticity of the alveolar walls.
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7
Q

Panacinar emphysema and lver cirrhosis developing in a young non-smoking patient is most likely due to what genetic disease?

A
  • alpha 1-antitrypsin deficiency
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8
Q

What are the common symptoms associated with COPD?

A
  • Cough
  • dyspnea
  • excessive sputum production
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9
Q

Patient with COPD have what typical findings on chest X-ray?

A
  • ususally normal, but in advanced disease you may see flattened diaphragms, enlarged lung fields, increased AP diameter or interstitial markings with bullae.
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10
Q

patients with COPD, have what typical findings in EKG?

A
  • usually normal but you may see
  • poor wave progression in this V1 to V6
  • right sided heart strain or
  • low voltage QRS due to increased chest diameter
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11
Q

Do you have to document a flow obstruction on PFT is to make the diagnosis of COPD?

A

Yes, COPD is not a clinical diagnosis, but one that is made by spirometry.

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12
Q

In COPD, is residual lung volume increased or decreased compared to patients without COPD?

A

increased.

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13
Q

In most COPD patients, what do spirometric measurements (FEV1, FEV1/FVC) show pre and post bronchodilator therapy?

A
  • Reduced FEV1 pre-bronchodilator therapy indicates airway obstruction.
  • airway obstruction is largely irreversible.
  • Some COPD patients show mild post-bronchodilator FEV1 improvement, especially if their disease has a component of asthma.
  • However, the post bronchodilator FEV1/FVC ratio ratio always remained below 0.7 in COPD.
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14
Q

The Global Initiative for Chronic Obstructive Pulmonary disease (GOLD) recommends taking diagnostic spirometric measurements after administration of a bronchodilator, to reduce testing variability.
According to GOLD what FEV1/FVC, and FEV1 values, are consistent with COPD?

A

According to GOLD in COPD, post bronchodilator FEV1/FVC is less than 0.7 and FEV1 one is less than 80% of predicted.

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15
Q

Mild (stage I) COPD

A
  • FEV1/FVC < 70%, FEV1 >/= 80% predicted
  • with or without symptoms
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16
Q

Mild (stage I) COPD

  • treatment
A
  • FEV1/FVC < 70%, FEV1 >/= 80% predicted
  • with or without symptoms
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17
Q

moderate(stage II) COPD

A
  • FEV1/FVC < 70%
  • FEV1 = 50- 80% predicted
  • dyspnea with exertion
  • with or without cough and sputum production
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18
Q

moderate(stage II) COPD

  • treatment
A
  • FEV1/FVC < 70%
  • FEV1 = 50- 80% predicted
  • dyspnea with exertion
  • with or without cough and sputum production
  • Short acting bronchodilators + one or more LABA or anticholinergics + pulmonary rehabilitation
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19
Q

Severe (stage III) COPD

  • treatment
A
  • FEV1/FVC < 70%
  • FEV1 < 30% - 50%predicted
  • increased dyspnea
  • reduced exercise capacity
  • fatigue
  • repeated exacerbations
20
Q

Severe (stage III) COPD

  • treatment
A
  • FEV1/FVC < 70%
  • FEV1 < 30-50% predicted
  • increased dyspnea
  • reduced exercise capacity
  • fatigue
  • repeated exacerbations
21
Q

Severe (stage IV) COPD

  • treatment
A
  • FEV1/FVC < 70%
  • FEV1 < 30% predicted or
  • FEV1 < 50% plus respiratory failure
22
Q

Severe (stage IV) COPD

  • treatment
A
  • FEV1/FVC < 70%
  • FEV1 < 30% predicted or
  • FEV1 < 50% plus respiratory failure

Treatment = - Short acting bronchodilators + one or more LABA or anticholinergics + pulmonary rehabilitation + inhaled glucocorticoids for repeated exacerbation + oxygen therapy +/- surgery

23
Q

Inhaled corticosteroids are the mainstay of pharmacology COPD therapy and should be prescribed as first line treatment for most patients.

True or False?

A
  • False
  • bronchodilators are central to symptomatic, management of COPD.
24
Q

What are the different classes of bronchodilators use in the treatment of COPD?

A
  • Anticholinergics eg. Ipratropium
  • Short and long acting beta agonist
  • Methylxanthines eg theophylline.
25
Q

How do anticholinergics help keep airways open?

A
  • they inhibit muscarinic cholinergic receptors and reduce intrinsic vagal tone of airways
26
Q

Do steriods slow the FEV1 decline of COPD?

A
  • No
27
Q

What is the benefit of steroids in a COPD patient?

A
  • They decrease exacerbations, and are useful in an acute setting.
28
Q

What are the only interventions that have consistently shown effectiveness in decreasing mortality due to COPD?

A
  • smoking cessation decreases the progression of lung damage due to COPD, no matter how early or advanced the disease.
  • Oxygen prolongs life in patients with oxygen insufficiency.
29
Q

What interventions improve morbidity in COPD patients?

A
  • medications
  • smoking cessation
  • oxygen therapy
  • Influenza and pneumococcal vaccines
  • pulmonary rehabilitation.
30
Q

what are the components of pulmonary rehabilitation?

A
  • Exercise conditioning
  • breathing retraining
  • education
  • psychological support.
31
Q

In what ways does pulmonary rehabilitation, improve morbidity due to COPD?

A

It enhances quality of life

  • by reducing anxiety and depression symptoms
  • reducing heart hospitalization rates, and
  • improving exercise performance.

It does not improve overall pulmonary function.

32
Q

What are the indications for continuous long term oxygen therapy in patients with COPD?

A
33
Q

Acute exacerbations of COPD

  • common cause
A
  • infections
    • viruses
    • bacterial
      • Streptococcus pneumoniae
      • Moraxella catarrhalis
34
Q

Acute exacerbations of COPD

  • causes
A
  • infections
  • cardiac conditions
    • cardiac failure
    • arrythmias
  • chest trauma
  • Pulmonary conditions
    • pnemothorax
    • PE
  • Iatrogenic
    • inappropriate doses of Beta-blockers
    • narcotics
35
Q

What are the symptoms acute exacerbation of COPD?

A
  • worsening dyspnea
  • chest tightness
  • cough
  • wheezing
  • increased sputum production/tenacity
36
Q

What are the physical signs indicate a severe exacerbation?

A
  • use of accessory muscles.
  • Paradoxical chest movement
  • cyanosis,
  • signs of heart failure
    • edema
    • hemodynamic instability
  • mental status changes.
37
Q

What conditions can mimic the COPD exacerbation?

A
  • infection(pneumonia)
  • Pulmonary Embolism
  • pneumothorax,
  • pleural effusion
  • cardiac condition
    • arrhythmias
    • heart failure.
38
Q

What is the workup of COPD exacerbation?

A
  • arterial blood gases,
  • Chest X-ray
  • ECG
  • labs - CBC, BMP, BMP
  • spiral CT of pulmonary embolism is suspected.
39
Q

What is the treatment for acute exacerbation of COPD?

A
  • bronchodilator therapy
  • oxygen - with the aim of keeping saturation between 90 and 94%.
  • Oral IV corticosteroids
  • antibiotics for exacerbation caused by bacterial infection.
40
Q

Why should you monitor PCO2 while on oxygen therapy?

A

Oxygen can decrease the respiratory drive, causing the individuals PCO2.

41
Q

What is the treatment for hypercapnia?

A
  • BiPAP followed by intubation if needed.
42
Q

What does BiPAP stand for?

A
  • Bi-level (variable) positive airway pressure
43
Q

What does BiPAP do?

A
  • Mechanically delivers air through a mask at one pressure for inhaling (high) and at another for exhaling (low).
44
Q

In COPD patients what are the most common causes of pneumonia?
.

A
  • Viruses
  • H influenza
  • S pneumonia
  • M catarrhalis
45
Q

What is cor pulmonale?

A
  • cor pulmonale is a right sided heart failure resulting from long term increased pressure in the pulmonary vasculature and right ventricle.
  • It can be caused by a number of chronic pulmonary conditions including COPD.
46
Q
A

General Medicine & Family Medicine (150 decks)

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