2 - COPD

Question 1

COPD is umbrella term for

Answer 1

Emhysema

Chronic bronchitis

Refractory asthma

Severe bronchiectasis

Question 2

3 defining characteristics of COPD

(3 P’s)

Answer 2

1. Preventable and treatable
2. Persistent airflow limitation
3. Progressive

Question 3

Chronic Bronchitis

Answer 3

Daily producive cough for three months or more in at leaast two consecutive years

Question 4

Emphysema

Answer 4

Permanent enlargement and destruction of airspaces distal to the terminal bronchiole

Question 5

CXR in emphesema

Answer 5

Enlarged air space and flattened diahragm

Question 6

COPD aka

Answer 6

COLD

CLRD

Question 7

Mechanisms underlying COPD

Answer 7

Small airway disease ****

Parenchymal destruction ****

Question 8

Risk factors for COPD

Answer 8

• Smoking
• Occupation
• Environmental tobacco smoke
• Pollution

Genes, Infections, Socioeconomic status

Question 9

gene for COPD

Answer 9

alpha 1 antitrypsin

Question 10

Dx of COPD

Answer 10

1. Symptoms (Cough, SOB, Sputum)
2. Exposure to risk factors
3. Spirometry***

**required for Dx!

Question 11

Spirometry measures

Answer 11

volume of air inhaled/exhaled, rate of air movement

Question 12

FVC

Answer 12

forced vital capacity

(from full inhale, breathe all the way out)

Question 13

FEV1

Answer 13

First second volume

4L is normal

Question 14

Important ratio in diagnosis of Obstructive Lung Disease

Answer 14

FEV1 / FVC

Low = obstructive

Ratio is normal = not obstructive, even if FVC low

Question 15

Normal FEV1 / FVC

Answer 15

0.8

Question 16

Obstructive disease has greater change in…

Answer 16

FEV1

Question 17

Restrictive lung disease has change in

Answer 17

FEV1 and FVC

–> ratio stays the same

Question 18

TLC change in obstructive/restrictive

Answer 18

DOWN = restrictive

UP = Obstructive

Question 19

Assessents for COPD

Answer 19

1. COPD assessment test (CAT)
2. Clinical COPD Questionnaire (CCQ)
3. mMRC Breathlessness Scale

Question 20

Most validated assessment tool for COPD

Answer 20

CAT

COPD assessment test

Question 21

GOLD critera catergorizes based on…

Answer 21

FEV1:FVC must be below 70%

If FEV1 more than 80% of predicted value = Mild

if less than 50% = Severe

Question 22

Normal spirometry varies based on

Answer 22

Height, age, gender, ethnicity

Question 23

FEV1 is Severe if

Answer 23

<35%

Question 24

Indicators of high risk COPD

Answer 24

1. Two or more exacerbations within the last year, or an FEV1 <50%
2. One or more hospitalizations for COPD exacerbataions

Question 25

COPD patients are at increased risk for:

Answer 25

* Cardiovascular disease * Osteoporosis * Resp infections, lung cancer, bronchiectasis * Diabetes * Depression/anxiety

Question 26

Occurs at any age

Answer 26

asthma (COPD is older than 35 yrs)

Question 27

Variable Smoking/dyspnea associations

Answer 27

asthma (COPD is typical, progressive)

Question 28

_Family history_, _Atopy_, and _diurnal symptoms_ are more common in

Answer 28

Asthma

Question 29

Additional Investigation measures

Answer 29

* CXR * Lung volumes * Oximetry and ABG * a1AT deficiency screening * Exercise testing (self paced/incremental) * Composite Scores

Question 30

COPD meds

Answer 30

* **Beta2 agonists** (first for asthma) * **Anticholinergics** (first for COPD) * Methylxanthines, Inhaled corticosteroids, PDE4 inhibitors TRIPLE THERAPY eventually needed for most pts ( BrA, Antichol, Steroid)

Question 31

Management for MILD COPD

Answer 31

*(FEV1/FVC \<70% with or without Sx)* **_Short acting bronchidilator_**

Question 32

mngmt of Moderate COPD

Answer 32

FEV1 between 50-80% * Regular Tx with one or more bronchodilators * REHAB * Inhaled CS's if significant Sx and lung function response

Question 33

Mngmt of Very Severe COPD

Answer 33

FEV1 less than 30% * Regular bronchodilator * Inhaled CS * Treatment of complications * Rehab * Long term O2 * Surgery possible

Question 34

Always offer this to COPD patients

Answer 34

Rehabilitation

Question 35

Increases survivla in pts with severe, resting hypoxemia

Answer 35

O2 therapy (long-term, **\>15hrs** per day)

Question 37

Surgical options for COPD

Answer 37

* LVRS (lung volume reduction surgery) (costly relative to health care programs that dont involve surgery) * Lung transplantation

Question 38

Two patient types that respond to Non-invasive ventilatory support (NIV)

Answer 38

COPD Pulmonary Edema

Question 39

LTOT indications -- If someone has 90% CO2 and PO2 \>60mmHg

Answer 39

None except with qualifier

Question 40

7 Causes of COPD exacerbation

Answer 40

1. Infection 2. PEdema 3. PEmbolism 4. Pneumothorax 5. Arrhyth. 6. Exposure 7. Non-compliance

Question 41

ABG

Answer 41

PaO2 \< 8.0kPa with or without PaCO2 \>6,7 kPa

Question 42

Useful to exclude alterntive diagnoses

Answer 42

CXR

Question 43

Target saturation with O2 Therapy

Answer 43

88-92%

Question 44

Hypoxic patient given too much oxygen causes

Answer 44

remove hypoxia in lungs dilation of pulm vessels blood goes to healthy AND damaged lung **Causes V/Q mismatch** (blood doesn't get oxygenated) --\> causes CO2 to increase

Question 45

Preferred bronchidilators

Answer 45

Short acting inhaled B2 agonists with or without short acting anticholinergics

Question 46

Anthonisen criteria

Answer 46

increased dyspnea increased sputum volume increased sputum purulence

Question 47

Anibiotics indicated for whom?

Answer 47

Those with three cardinal (**Anthonisen**) symptoms Those who are on **mechanical ventilation**

Question 48

\_\_\_\_\_\_\_ for pts hospitalized for acute exacerbations of COPD

Answer 48

NIV * *Improves resp acidosis* * *Decreases RR and mortality*

Question 49

5A's

Answer 49

Ask Assess Advise Assist Arrange

Question 50

Intervention plans for smoking

Answer 50

Behavioral (self help, advice, counseling, exercise) Pharmacologic (Nicotine replacement, bupropion, varenicline, Ecig)

Question 51

In one year of smoking cessation

Answer 51

50% Cardiac disease risk