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Cardio Exam 3 > 36 - COPD > Flashcards

36 - COPD Flashcards

1
Q

What is COPD?

A

A disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases

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2
Q

How common is COPD?

A
  • 4th largest killer in US

- 16 million affected

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3
Q

What is the most significant risk factor for COPD?

A

Tobacco

Worse with cigarettes but also increased for cigar and pipe smokers; passive smoke may contribute

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4
Q

What are other risk factors for COPD?

A
  • Occupational dusts and chemicals
  • Outdoor and indoor pollution
  • Infections
  • Socioeconomic status
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5
Q

What percent of COPD patients are smokers?

A

90%

  • These patients have the highest prevalence and death rates from COPD
  • Quicker decline (determined by FEV1)
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6
Q

How many smokers develop COPD?

A

1 in 7
- This increases with history of airway reactivity, family history of COPD, childhood lung disease, occupational dust exposure

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7
Q

How can you subjectively diagnose COPD?

A
  • Complaint of SOB/dyspnea on exertion (DOE)
  • Cough
  • Recent increase or decrease in sputum production
  • My report increased “purulence” of sputum
  • History of exposure to risk factors (tobacco, dust/chemicals/etc.)
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8
Q

How can you diagnose COPD using physical exam findings?

A

In general…

  • Thin person sitting upright and leaning forward with pursed lips
  • Can appear cachectic, wasted, discolored, wrinkled, baggy, blue, haggard
  • Tachypnea with use of accessory muscles (so you know they are significantly out of breath)
  • Increased AP and lateral diameter (barrel chest) - hyperinflation
  • Percussion = hyperresonance
  • Auscultation = wheezes, rhonchi, decreased breath sounds
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9
Q

What tests can you run on a patient you are suspecting COPD for?

A
  • FEV1 (forced expiration in 1 second)
  • PERF = peak expiratory flow rate
  • ABG = arterial blood gas
  • CBC = complete blood count
  • Sp02 = pulse ox for oxygen saturation
  • ECG = electrocardiogram
  • CXR = chest x-ray
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10
Q

What are some potential findings on a chest x-ray?

A
  • Bullae or blebs (the “meat” of the lung has been replaced by thin tissue with little pockets of air called blebs or bulae)
  • Decreased vascular markings
  • lncreased retrosternal airspace are observed on the lateral projection
  • Hyperlucency of the lungs
  • Elongated, narrow heart shadow
  • Low, flat diaphragm. Downgoing diaphragm (frowning from having to breathe in smoke)
  • Silo lungs (long tall lungs) – you can see a lot of ribs here, can’t normally see so many
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11
Q

What do you need to demonstrate during testing in order to make a COPD diagnosis?

A

Requires demonstratable obstruction based on spirometry

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12
Q

What things would be on your differential list before making a COPD diagnosis?

A
  • Asthma
  • Cystic Fibrosis
  • Coronary Artery Disease or “Coronary Equivalent”
  • Congestive Heart Failure
  • Acute Infection
  • Pulmonary Emboli
  • Alpha –1-Antitrypsin deficiency
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13
Q

Distinguishing between asthma and COPD…

Did the symptoms begin after age 40?

A

Asthma tends to occur before age 40

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14
Q

Distinguishing between asthma and COPD…

Are the symptoms progressive or episodic?

A

Asthmatics have a flare-up then symptoms go back down to base line

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15
Q

Distinguishing between asthma and COPD…

Current or prior cigarette smoking?

A

Points towards COPD

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16
Q

How do you treat mild COPD?

A

Begin with inhaled rather than systemic agents

  • Short acting bronchodilators
  • Short acting anticholinergics
17
Q

What are short-acting bronchodilators?

A
  • These alleviate shortness of breath and improve exercise tolerance
  • “rescue inhaler”
  • Beta-2 agonists
  • Example = ALBUTEROL
18
Q

What are short-acting anticholinergics?

A
  • Work more slowly than albuterol
  • Take 2-4 puffs per day throughout the day
  • Example: (e.g. Albuterol + Ipratropium Bromide(Atrovent) = Combivent)
19
Q

How do you treat moderate COPD?

A
  • Either begin with short-acting (like in mild) or add a long-acting bronchodilator
  • This will depend on the severity of symptoms
20
Q

What are the two long acting bronchodilators?

A
  • Long-acting anticholinergic (tiotropium - Spiriva*)

- Long-acting Beta-2 agonists (Salmeterol or Formoterol)

21
Q

When would you consider a short-term pulmonary rehab program?

A
  • Anxiety w/ activity
  • Breathlessness and limitations on activity
  • Loss of independence
22
Q

How do you treat severe COPD?

A
  • Short and Long term bronchodilators
  • Consider adding an inhaled corticosteroid (especially if they have frequent exacerbations) - Fluticasone
  • Incorporate long-term pulmonary rehab
  • Consider at home oxygen
23
Q

What is the purpose of pulmonary rehab?

A

To Control and alleviate symptoms, optimize function and reduce the medical and economic burden of disease

24
Q

What does pulmonary rehab consist of?

A

-Includes education, respiratory and chest physiotherapy , psychosocial support and exercise training.

25
Q

What is the goal of pulmonary rehab?

A

Goal = Restoration of the patient to their highest possible level of independent function.

26
Q

What are the benefits of pulmonary rehab?

A

Benefits = Improved exercise tolerance and symptoms, reduced hospitalizations, reduced use of expensive medical resources.

27
Q

What are the criteria for at-home oxygen?

A
  • PO2
28
Q

What is the most important “hurdle” to effective treatement of COPD?

A

The patient continues to smoke

29
Q

What are other barriers to effective treatment?

A
  • High cost
  • Mix up inhalers
  • Medication side effects so they don’t take them
  • Non-compliance
30
Q

What is a COPD exacerbation?

A

Acute deterioration in respiratory status

31
Q

What are the 3 major criteria for diagnosing a COPD exacerbation?

A

1 - Increase in sputum VOLUME
2 - Presence of sputum purulence (generally yellow/green)
3 - Worsening dyspnea

32
Q

What is a severe COPD exacerbation (type 1)?

A

If you have all three, it would be classified as a “severe” or type I exacerbation

33
Q

What is a moderate COPD exacerbation (type 2)?

A

If you have 2/3, it would be classified as a “moderate” or type 2 exacerbation

34
Q

What is a mild COPD exacerbation (type 3)?

A

If you have 1/3 PLUS one of the following conditions it would be classified as a “mild” or type 3 exacerbation

  • An upper Respiratory Infection in the past 5 days
  • Fever without another apparent cause
  • Increased wheezing
  • Increased cough
  • Increase in respiratory rate or heart rate 20% above baseline
35
Q

Describe the key steps in emergently assessing for a COPD exacerbation (H&P)

A

History and physical exam

  • Determine baseline function
  • Evaluate for pneumonia, CHF, MI, PE, pneumothorax, pleural effusion
  • Look for any of the following:
    - Decreased breath sounds
    - Jugular Venous Distention
    - Difficulty speaking secondary to dyspnea
    - Altered Mental Status
    - Exacerbation of comorbidities
    - Hemodynamic instability
36
Q

Describe the key steps in emergently assessing for a COPD exacerbation (testing)

A 
ABG
Chest X-Ray
Oximetry monitoring
EKG
Labs
37
Q

If you are able to manage a COPD exacerbation in the outpatient setting, how would you do so?

A
  • Up to 2 weeks oral corticosteroids
  • Increase dose of short-acting bronchodilators
  • Consider antibiotics if pulmonary infection
  • Also: Chest PT, Relaxation techniques, Breathing control techniques, Nutritional intervention
38
Q

What patients will you need to manage a COPD exacerbation in the inpatient setting?

A

Those who do not respond to outpatient therapy

Those who show 2 or more of the following, indicating severe exacerbation:

  • Dyspnea at rest
  • Respiratory rate > 25 per minute
  • Heart rate > 100 beat per minute
  • Use of accessory muscles

Cardio Exam 3 (13 decks)

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