COPD

Question 1

What is the hallmark of advanced COPD

Answer 1

Extensive small airway destruction

Question 2

What are the 4 characteristic of Emphysema

Answer 2

Chronic cigarette exposure
Compromised airway vasculature and gas exchange
Structural cell death
Disordered repair of elastin and other components

Question 3

Define the characteristics of small airway disease

Answer 3

Small airways <2mm
Goblet cell metaplasia
Smooth muscle hypertrophy
Luminal narrowing

Question 4

Characteristics of chronic bronchitis

Answer 4

Mucus gland enlargement
Goblet cell hyperplasia w/ cough and mucus production

Question 5

S/S of COPD

Answer 5

Prolonged expiratory phase
Expiratory wheezes
Barrel chest
Accessory muscle use
Tripod positioning
Cyanosis in lips and nail beds
Digital clubbing
Hyperinflation on CXR

Question 6

COPD lab results and diagnostic tests

Answer 6

ABG: resting Exertional hypoxemia, pCO2>45, impending acute exacerbation, elevated hematocrit, RVH
CXR: increased lung volumes with flat diaphragm
CT Chest: definitive to establish presence/absence, Determine any coexisting diseases

Question 7

COPD pulmonary function tests

Answer 7

Reduced FEV1 and FEV1/FVC

Question 8

Chronic COPD management

Answer 8

Anticholingeric muscarinic antagonists: SAMA (atrovent) LAMA (Spiriva)
Beta agonist: SABA (albuterol) LABA (Brovana)
Inhaled corticosteroids: Pulmicort
Combo therapies: Advair, Symbicort, trelegy

Question 9

Acute COPD exacerbation treatment plan

Answer 9

Dual SABA/SAMA (duoneb)
Brovana new and pulmicort neb
Solumederol: transition to oral dose, avoid chronic use
Zyrtec and singulair
BiPAP vs Intubation
Chronic NIV