Lecture 57 - COPD tx and Dx

Question 1

what two diseases Comprise COPD? what is the difference between the 2?

Answer 1

Emphysema – Parenchymal destruction:
Enlargement of Air Spaces and Destruction of alveolar walls
Increased Compliance; Decreased Recoil

Chronic Bronchitis :
Presence of cough and sputum production for a least 3 months in two consecutive years

Question 2

History and Physical of COPD

what is notably absent from the physical exam?

Answer 2

Dyspnea
Cough
Symptoms can worsen with stimuli

Exam: Barrel chested, pursed lips, rhonchi

notably absent: Clubbing of the fingers

Question 3

what else is used to diagnose COPD?

Answer 3

Imaging – (CT)

and PFTs

Question 4

What are some PFT findings of obstructive pulmonary disease?

what is the DLCO finding ? how does it differ for Emphysema vs Chronic bronchitis vs asthma /

Answer 4

PFTs - Very Decreased FEV1; Decreased FVC

	Lung Volumes --- can show hyperinflation; Increased TLC, FRC and RV 

DLCO – reduced by emphysema;
Not reduced is asthma and CB

Question 5

Describe the physiology behind the obstruction of emphysema ?

Answer 5

Emphysema – loss of elastic recoil due to degradation of the collagen and elastin

airway becomes collapsible

Question 6

What is the old way of staging criteria for COPD? what metric is used ?

Answer 6

GOLD CRITERIA FEV1/FVC < 70% == Obstructive Disease

Grade severity by FEV1 % of predicted
Mild - < 80%
Moderate - 50-79%
Severe - <50%

Question 7

what are the three criteria used in the new method of risk stratification of COPD?

Answer 7

PFT (GOLD)

Risk (exacerbation hx)

Breathlessness Symptoms (CAT or mMRC questionnaires)

Question 8

what two “treatments” are proven to improve mortality of COPD?

Answer 8

Smoking Cessation – improves mortality

Oxygen – Improves mortality

Question 9

what medications can be used for lower 2 stages of COPD?

Higher two stages of COPD?

Answer 9

SABA, SAMA PRN
LABA, or LAMA

ICS + LABA

Question 10

what is common complication of COPD
how is it provoked?
how is it treated?

Answer 10

COPD exacerbation –

Provoked – viral or bacterial respiratory infeciton; pulmonary embolism

Treatment: Beta 2 agonits; corticosteroids; abx; oxygen

Question 11

What is pulmonary rehab?

Answer 11

○ Mutlidisciplinary program of medication and exercise to break the downward spiral of respiratory impariment leading to abstaining from exercise leading to deconditioning eventually leading to dyspnea during ADLs

Question 12

what is lung volume reduction surgery?

Answer 12

○ Removal of emphysematous blebs, that take up space, worsening lung mechanics and don’t really do anything for gas exchange
○ Removal – can imporve elastic recoil, improve symptoms

Question 13

what is the BoDE criteria?

Answer 13

Criteria for risk stratification and survival

• BMI

• Degree of airflow obstruction and Dypnea  Exercise Capacity