Unit 3-COPD Flashcards
Essentials of dx for COPD
hx cig smoking
chronic cough, dyspnea, sputum production
rhonchi, decreased intensity of breath sounds and prolonged expiration
airflow limitation of PFT that is not fully reversible and progressive
COPD prevention
elimination of tobacco
COPD
presence of airflow obstruction d/t chronic bronchitis of emphysema. May be accompanied by hyper reactivity and may be partially reversible
Late-stage COPD complications
pulm HTN
Cor pulmonale
chronic respiratory failure
mMRC dyspnea scale
Grade 0: only breathless w/ strenous exercise
grade 2: walk slower than people same age, stop for breath when walking on own pace
grade 4: too breathless to leave the house or breathless when dressing/undressing
s/sx COPD
excessive cough, sputum and chronic/progressive dyspnea
periodic exacerbation of sx beyond normal day to day variation including: dyspnea, increase frequency and severity of cough, increased sputum, change in sputum
goal of assessment for COPD
determine airflow limitation, impact of disease on pt health and risk of future events >help guide therapy
T or F: dyspnea at rest indicates mild disease
FALSE
it indicates severe disease
what are the 2 patterns that emerge with progression?
- pink puffers emphysema predominant
2. blue bloaters chronic bronchitis predominant
What is chronic bronchitis?
excessive secretions of bronchial mucus with daily cough for 3 months for at least 2 consecutive years
BLUE BLOATERS- overweight d/t activity intolerance, elevated hgb, periheral edema d/t RHF, rhonchi and wheezing, chronic and productive cough, PaCo2 elevated
Dx tests of COPD
- increase total lung capactiy
- increase residual vlm
- decrease FEV1 and FVC>air trapping
- FEV1<40%: hypoxemia or hypercapnia
What is reuired to make diagnosis of COPD
spirometry
The presence of post-bronchodilator FEV1/FVC <70 confirms presence of persistent airflow limitation
dx tools for COPD
ABG=hypercapnia>chrnic resp acidosis> chronic resp failure
Sputum=test for colonization in bronchitis
CXR=insensitive for dx show hyperinflation w/ flattening of diaphragm
CT:more sensitive and specifi for dx
Empysema
abnormal permanent enlargement of air spaces to distal to terminal bronchiole w/ destruction of walls without obvious fibrosis
Abnormal PERMANENT enlargement and destruction of alveoli and terminal bronchiole
PINK PUFFER- older, thin, severe dyspnea, quiet chest, hyperinflated lungs and flattened diaphragm on x-ray, cough is rare, PaCo2 is normal
Mild COPD treated with?
SABA
Moderate COPD treated with
SABD’s plus abx and PO steroids
Blood ______ may predict exacerbation rates in pt tx w/ LABA without ICS
eosinophils
When to refer COPD
COPD before 40
exacerbation 2 or more despite tx
severe or rapidly progressive sx disproportionate to severity of aiflow obstruction
need for long term O2
onset of comorbid illness
Prevention in COPD
Smoking cessation
T or F: inhaler technique should be checked at each pt visit to continue to use correctly
TRUE
What two vaccines helps with COPD
Influenza
Pneumococcal
_________ improves s/sx, quality of life, and ADLS
pulmonary rehab
What agents are preferred over short acting agains in t with only occasional dyspnea
a. corticosteroids
b. LABA and LAMA
c. inhaled steroids
d. none of the above
B. LABA and LAMA
Which is preferred in COPD?
a. inhaled bronchodilators
b. PO bronchodilators
c. Inhaled steroids
d. PO steroids
A. inhaled bronchodilators
______ is NOT recommended unless other long-term tx bronchodilators are unavailable or unaffordable
Theophylline.
Phosphodiesterase inhibitor
T or F: long-term monotherapy with ICS is recommended
FALSE
It is NOT recommended, but may be considered given with LABA for pt with hx of exacerbation despite tx with long-acting dilators
T or F: long-term PO corticosteroids are recommended
FALSE
What medication class may be considered if LABA/ICS and LABA/LAMA/ICS still have severe airflow obsturction
PDE4- Phosphodiesterase inhibitor
May medication may be considered with former smoker w/ exacerbations despite appropriate therapy?
a. PO steroids
b. Macrolides (azithro)
c. PDE4
d. Inhaled steroids
B.
Macrolides such as azithromycin can be considered
T or F: Statin therapy and antixodant mucolytics are both recommended for exacerbations
FALSE
STATINS= NOT RECOMMENDED
ANTIXODANT MUCOLYTICS ARE RECOMMENDED in select pt
T or F: starting pharmacoligcal tx in newly dx COPD pt is recommended
FALSE
There is lack of evidence supporting it
GROUP A, 0-1 moderate exacerbations, mmMRC 0-1, CAT <10
All should be offered BRONCHODILATOR tx based on effect on breathlessness (short or long acting)
should be continued if benefit is documented
GROUP B, 0-1 moderate exacerbation, mmMRC >=2, CAT >=10
Initial therapy should consist of long acting bronchodilator (LABA or LAMA)
Laba superior to short-acting dilators taken PRN
SEVER breathlessness: consider initial therapy w/ 2 bronchodilators
pt likely to have comorbidities that add to sx and impact prognosis
GROUP C, >=2 moderate exacerbation or >=1 leading to hospital admit, mmMRC 0-1 CAT <10
initial therapy should be single long acting bronchodilator (LAMA)
GROUP D, >=2 moderate exacerbations or >=1 hospital admit, mmMRC >=2, CAT >=10
Therapy with LAMA
CAT >=20 (severe breathlessness w/ exercise limits) LAMA/LABA or
ICS+LABA if eos>= 300
Medications for smoking cessations include:
a. bupropion
b. varenicline
c. cysteine
d. all of the above
D. all of the above
First line for COPD
a. LABA and SABA
b. LABA and ICS
c. SABA and ipratropium bromide
d. SAVA and SABA
C. SABA and ipratropium bromide
T or F: SABA are less expensive and better pt satisfaction
TRUE
SABA and anticholinergics improve bronchodilation but do not improve _____
a. nighttime awakenings
b. exercise fatigue
c. dyspnea
d. oxygen demand
D. Dyspnea
T or F: LABA and ipratropium achieve or beat bronchodilation
TRUE
Corticosteroids:
a. reduce exacerbations
b. impact mortality rate
c. improve functional status
d. Improve lung function
e. all of the above
f. A, C, D
F. reduce exacerbation no impact mortality rate improve lung functional status reduce decline in lung status
Trial corticosteroids for 3-4 weeks, if improvement in FEV! by ___% or greater, continue inhaled agent
a. 15%
b. 45%
c. 20%
d. 50%
C. 20%
Theophylline
4th line tx for pt with inhaled anticholinergics, beta 2, and corticosteroids
improved hgb during sleep and sleep disorders.
Improves dyspnea rates, exercise performance, and pulm function
T or F: Theophylline causes brochodilation, and has anti-inflammatory properties
TRUE
DOES have narrow therapeutic range
T or F: You have to monitor ranges when given theophylline
TRUE
very narrow range
Abx improve outcomes in COPD with what pt?
a. acute exacerbation
b. acute bronchitis
c. prevent acute exacerbation in chronic bronchitis
d. all of the above
D all of the above
Those that benefit the most are those with increased sputum purulence accompanied by dyspnea or increase in quantity of sputum
ABX that can be used?
Doxy Bactrim Cephalosporins MACROLIDES Fluoroquinolones Augmentin
DURATION 3-7 days
give if high risk: >65, FEV1 <50%, 3 or more exacerbations/year, abx past 3 mo, comorbid conditiosn
Goal of pulmonary rehab a. improves exercise capacity b. decrease hospitalizations c. enhance quality of life d all of the above
D. all of the above
Teach pt
avoid cough suppressants and sedatives
adequate hydration
handheld flutter valve
postural drainage and chest percussion in thsoe w/ excessive secretions
