Week 2 Flashcards
COPD signs and symptoms
Cardinal symptoms of COPD include dyspnea, chronic cough, and or sputum production
Other signs and symptoms include decreased activity tolerance, wheezing, recurrent lower respiratory infections, chest tightness, fatigue, weight loss, anorexia, increased anterior posterior diameter of the thorax, use of accessory muscles for aspirations, prolonged expiration, hyperresonance on percussion, decrease heart/breath sounds, tachypnea, neck pain dissension during expiration and absence of heart failure, cyanotic skin color and clubbing of nail beds
COPD
Obstructive disease not fully reversible due to airflow limitations and hyper reactivity of airways, hyperinflation of lungs
Exacerbations and comorbidities determine the severity
COPD risk factors
Smoking, aging high and 65 to 75 year old, recurrent infections, repeated chemical/gases/irritants exposures, long-term asthma, alpha-1 antitrypsin defficiency
COPD diagnostic criteria
Gold standard is spirometry testing. Should be done and symptomatic patients only.
FEV1/FVC less than 0.70 & FEV1 less than 80%
Chest x-ray is not used to diagnose COPD however can rule out other diagnoses such as CHF, pneumonia, cardiomegaly, and pulmonary fibrosis
Spirometry testing for COPD
Symptoms for considering a diagnosis and performing spirometry including dyspnea, cough, chronic sputum production, recurrent lower respiratory tract infections, history of risk factors including family history of COPD and or childhood factors
COPD stage of severity
Stage 1: mild COPD
FEV1 greater or equal to 80% predicted
COPD stage of severity
Stage 2: moderate COPD
FEV1 less than 50% to less than 80% predicted
COPD stage of severity
Stage 3: severe COPD
FEV1 greater than 30% to less than 50% predicted
COPD stage of severity
Stage 4: very severe COPD
FEV1 less than 30% predicted
Management of COPD
Smoking cessation, flu vaccination annually, pneumonia vaccination at the age of 65 and older, reduce risk factor exposures, person centered and shared decision-making management plan, pulmonary rehab, oxygen use
COPD medication goals
Reduce symptoms, reduce exacerbations risk in severity, and prove exercising overall health
COPD radiographic findings
Chest x-ray alone is not diagnostic of COPD but can provide value in excluding differential diagnosis such as pulmonary disease, pneumonia, cardiomegaly.
Abnormalities associated with COPD may be present on a chest x-ray findings such as hyper inflation of the long, hyperlucency of the long, or tapering of vascular markings. Structural long disease may be seen on the chest imaging which is consistent with COPD.
COPD lab test
CBC with differential to rule out anemia, polycythemia which occurs in advanced COPD with hypoxemia, detecting the presence of infection with the white blood cell count, or if eosinophilia is present, considering an allergic/asthmatic component
Serum alpha-1 anti-trips in levels are recommended for individuals presenting with COPD at early ages less than 45 years in age and in non-tobacco users with emphysema or family history of COPD
COPD EKG changes
And COPD patients atrial arrhythmias are common. Peaked P waves and leads II, III, and AVF are often apparent in patients with pulmonary disease. An EKG in advance COPD may demonstrate evidence of a right axis deviation, sinus tachycardia, and pulmonary hypertension with the presence of ongoing as waves in the lateral precordial leads.
COPD exacerbations medication management
Usually occurs after URI‘s
Mild: Saba only
Moderate: Saba and oral corticosteroids
Severe: ER/hospital for acute respiratory failure
COPD action plan imperative to reduce rest of future exacerbation
COPD pharmacological treatment
SABA
Bronchodilation, relaxes smooth muscles in airway. Rapid onset. Rescue medication
Examples include albuterol, levoalbuterol, pirbuterol every 4-6 hours
COPD pharmacological treatment
LABA
Bronchodilation, relaxes smooth respiratory muscles. Onset 10 to 20 minutes
Examples include salmeterol, formoterol every 12 hours
Daily LABAs include indacaterol and olodaterol
COPD pharmacological treatment
Inhaled anti-cholinergics antimuscarinic
SAMA
Used in acute and maintenance
Blocks bronchoconstriction of acetylcholine
Caution and gloves, patience, BPH, bladder neck obstruction, allergy to atropine.
Anticholinergic side effects include can’t see, I can’t pee, I can’t spit, I can’t shit
Examples include ipratropium every 6-8 hours
COPD pharmacological treatments
Inhaled anti-cholinergics LAMA
Maintenance treatment
Prevents bronchoconstriction, causes some bronchodilation
Caution and glaucoma patients, BPH, bladder neck obstruction, allergy to atropine
Examples include Tiotropium (Spiriva) and Umeclidinium (Ellipta) every 24 hours
COPD pharmacological treatment
Combo LABA with ICS
FEV1 less than 60%. Best and combo with bronchodilators
Play improved bronchodilation reducing inflammation
Examples include Budesonide/formoterol (Symbicort), fluconazole/salmeterol (Advair), Vilabterol/flucanazole (Breo Ellipta)
COPD pharmacological treatment
Systemic steroids
Short term used for a cute exacerbations
Anti-inflammatory actions
Examples include prednisone
COPD pharmacological treatments
Methylxanthines
Risk for toxicity, drug interactions, toxic ADR
Oral bronchodilator
Examples include Theophylline
