36 - COPD Flashcards
What is COPD?
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
How common is COPD?
- 4th largest killer in US
- 16 million affected
What is the most significant risk factor for COPD?
Tobacco
Worse with cigarettes but also increased for cigar and pipe smokers; passive smoke may contribute
What are other risk factors for COPD?
- Occupational dusts and chemicals
- Outdoor and indoor pollution
- Infections
- Socioeconomic status
What percent of COPD patients are smokers?
90%
- These patients have the highest prevalence and death rates from COPD
- Quicker decline (determined by FEV1)
How many smokers develop COPD?
1 in 7
- This increases with history of airway reactivity, family history of COPD, childhood lung disease, occupational dust exposure
How can you subjectively diagnose COPD?
- 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.)
How can you diagnose COPD using physical exam findings?
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
What tests can you run on a patient you are suspecting COPD for?
- 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
What are some potential findings on a chest x-ray?
- Bullae or blebs (the “meat” of the lung has been replaced by thin tissue with little pockets of air called blebs or bulae)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
What do you need to demonstrate during testing in order to make a COPD diagnosis?
Requires demonstratable obstruction based on spirometry
What things would be on your differential list before making a COPD diagnosis?
- Asthma
- Cystic Fibrosis
- Coronary Artery Disease or “Coronary Equivalent”
- Congestive Heart Failure
- Acute Infection
- Pulmonary Emboli
- Alpha –1-Antitrypsin deficiency
Distinguishing between asthma and COPD…
Did the symptoms begin after age 40?
Asthma tends to occur before age 40
Distinguishing between asthma and COPD…
Are the symptoms progressive or episodic?
Asthmatics have a flare-up then symptoms go back down to base line
Distinguishing between asthma and COPD…
Current or prior cigarette smoking?
Points towards COPD
How do you treat mild COPD?
Begin with inhaled rather than systemic agents
- Short acting bronchodilators
- Short acting anticholinergics
What are short-acting bronchodilators?
- These alleviate shortness of breath and improve exercise tolerance
- “rescue inhaler”
- Beta-2 agonists
- Example = ALBUTEROL
What are short-acting anticholinergics?
- Work more slowly than albuterol
- Take 2-4 puffs per day throughout the day
- Example: (e.g. Albuterol + Ipratropium Bromide(Atrovent) = Combivent)
How do you treat moderate COPD?
- Either begin with short-acting (like in mild) or add a long-acting bronchodilator
- This will depend on the severity of symptoms
What are the two long acting bronchodilators?
- Long-acting anticholinergic (tiotropium - Spiriva*)
- Long-acting Beta-2 agonists (Salmeterol or Formoterol)
When would you consider a short-term pulmonary rehab program?
- Anxiety w/ activity
- Breathlessness and limitations on activity
- Loss of independence
How do you treat severe COPD?
- 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
What is the purpose of pulmonary rehab?
To Control and alleviate symptoms, optimize function and reduce the medical and economic burden of disease
What does pulmonary rehab consist of?
-Includes education, respiratory and chest physiotherapy , psychosocial support and exercise training.
