COPD, D Kinder, DSA

Question 1

onset COPD

Answer 1

middle age or elderly 20-30 yrs after exposure

Question 2

what is leading cause of COPD

Answer 2

smoking

Question 3

what other exposures can lead to COPD

Answer 3

workplace dusts from mining, cotton mills and grain handling facilities

Question 4

what is genetic predisposisition to COPD

Answer 4

alpha 1 antitrypsin deficiency

Question 5

emphysema

Answer 5

enlargement of air spaces distal to terminal bronchiole with destruction of alveolar wlals
imbalance of elastase anti-elastase in lungs

Question 6

what is centriacinar emphysema

Answer 6

respiratory bronchioles distal to terminal bronchiole and the remainder is spared
smoking

Question 7

what is pancacine emphysema

Answer 7

alveolar ducts, adjacent alveoli coalescence and bullae formation
common in alpha 1 antitrypsin deficiency
occurs with smoking

Question 8

what is most severe form of COPD

Answer 8

combined centriacinar and panacinar

Question 9

what is chronic bronchitis and bronchiolitis

Answer 9

enlargement of bronchial mucous glands and increased epithelial goblet cell production leads to cough and icnreased mucous production

Question 10

how does emphysema lead to pulmonary HTN

Answer 10

hypoxemia leads to vasoconstriction and increased pulmonary vascular R in small pulmonary aa
leads to vascular remodeling including medial smooth mm enlargement and intimal fibrosis

Question 11

What happens to elastic recoil in COPD

Answer 11

decreased and airway resistance is increased

Question 12

what acid base can COPD lead to

Answer 12

hypercapnea so respiratory acidosis

Question 13

What is significatn in Hx for COPD

Answer 13

current or past smoking, dyspnea with slow progression, Hx of acute bronchitis, chronic cough sputum production and wheezing

Question 14

What are physical findings of COPD

Answer 14

barrel chest, prolonged expiratory phase, accessory muscle use, low diaphragm, distant heart sounds, diminished breath sounds, rhonchi, wheezing, cyanosis, pedal edema, distended jugular veins, hepatic congestion and cachexia

Question 15

Stage I PFT for COPD

Answer 15

mild FEV1/FVC 80%

Question 16

Stage II PFT for COPD

Answer 16

moderate FEV1/FVC <80%

Question 17

Stage III PFT for COPD

Answer 17

severe FEV1/FVC <50%

Question 18

Stage IV PFT for COPD

Answer 18

very severe FEV1/FVC <50% plus chronic respiratory failure

Question 19

CXR for COPD

Answer 19

hyperinflation, flattened diaphragm, increased retrosternal space, bullae

Question 20

Ddx for COPD

Answer 20

asthma, bronchiectasis, bronchiolitis obliterans

Question 21

Tx COPD

Answer 21

stop smoking

bronchodilators

Question 22

What bronchodilator can increase FEV1 by 50 ml and reduce COPD excacerbations

Answer 22

phosphodiesterase 4 inhibitors

roflumilast

Question 23

Why is O2 Tx helpful in COPD

Answer 23

chronic hypoxemia can lead to pulm HTN and cor pulmonale

Question 24

What additional immunizations should patients with COPD receive

Answer 24

influenza and pneumococcus

Question 25

what are surgical options for COPD

Answer 25

lung volume reduction surgery used in severe emphysema in upper lobes
lung transplanataion for severe incapacitation must have no other comorbidities

Question 26

What is a COPD exacerbation

Answer 26

dyspnea, cough and productive sputum that is worse than usual

Question 27

What type of infections are more common with COPD

Answer 27

H influenze, S penumoniae, M catarrhalis
Pseudomonas and enteric bacilli
Viral: rhinovirus, influenza, parainfluenza, respiratory syncytial virus

Question 28

what do you hospitalize COPD patients for

Answer 28

dyspnea, accessoyr muscle use, ABG, hemodynamic stability
antibiotics if purulent sputum
systemic corticosteorids
increase short acting bronchodilator frequency
O2 maintained 90% sat
noninvasive +pressure ventilation

Question 29

prognosis COPD

Answer 29

50% patients with FEV1 40% survive 5 yrs
smoking cessation reduces mortality in patients with mild to moderated COPD
O2 reduces mortality in subset with chronic hypoxemia