Shortness of Breath with Dr. Johns Part II Flashcards
(35 cards)
What is dyspnea?
abnormally uncomfortable awareness of breathing
What is on the differential diagnosis for dyspnea on exertion?
CHF angina obstructive lung disease pleural effusion anemia hypohtyroid metabolic acidosis anxiety with hyperventilation
What is COPD’s rank in cause of death in the US?
4th
How is COPD defined?
disease state characterized by airflow limitation that is not fully reversible
progressive and associated with an abnormal inflammatory response of the lungs ot noxious particles or gases
What is chronic bronchitis defined as?
chronic productive cough for three months in two successive years
What is emphysema defined as?
enlargement of airspaces with destruction o bronchiole walls
actually a pathological term
How is asthma defined?
inflammatory disease of airways with significantly REVERSIBLE narrowing
What is the main difference between asthma and COPD?
COPD is permanent and asthma is reversible - but you can have combinations of the two
Who usually gets COPD?
patients who have smoked at least 20 cigarettes per day for 20 or more years
How does COPD usually start symptomatically? When does the dyspnea develop?
chronic cough
dyspea typically doesn’t start until 10-20 years after the cough
What is the main way to establish a diagnosis of COPD?
spirometry
As COPD proresses, what are some symptoms you can expect?
chronic clear sputum production weight loss morning headache hypercapnia with hypoxemia cor pulmonale
IN general, what happens to FEV1 as a person ages normally, ages with asthma and ages with COPD?
FEV1 decreases for all of them, but normal and asthma don’t really differ while people with COPD have a significant decline in FEV1 as they age
What are some physical exam findings you’ll see in COPD?
prolonged expiration hyperinflation - barrel chest hyperresonant percussion depressed diaphragm decreased breath sounds wheezes use of accessory muscles pursed lips cyanosis enlarged liver asterixis
How can you differentiate a pulmonary funtion test abnormality due to asthma from that of COPD?
give a bornchodilator and retest - asthma will improve and COPD won’t
What are some of the findings you would see on CXR for COPD?
hyperlucent lung fields vascular crowding with curvilinear pattern increased anteroposterior diameter flattening of diaphrgm increased retrosternal air space
What happens to FEV1 and FEV/FVC do in COPD?
both go down
What’s the number one thing to do for management of stable COPD?
get them to stop smoking - it can slow the decline in FEV1
What are the two main drugs we use in COPD?
beta-2 agonist bronchodilators (albuterol inhaler prn)
anticholinergic agents (inhaled ipratropium)
What COPD drug is controversial due to high risk of toxicity?
theophylline
When should you use corticosteroids in COPD?
some studies show inhaled corticosteroids may slow the rate of FEV1 decline
consider short term oral use for exacerbations. long term ONLY if all other meds are at maximal therapy
When should you prescribe supplemental oxygen in COPD?
if O2 aturations goes below 88% room air or falls below 85% with exertion
or if cor-pulmonale present
What are the three types of COPD?
asthma, emphysema and chronic bronchitis
What’s been happening to the prevalence of asthma?
increaseing
