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Junior - Pulm Mod 1 > 4 - COPD > Flashcards

4 - COPD Flashcards

1
Q

What is COPD?

A

Progressive airflow obstruction secondary to:

  • chronic bronchitis
  • emphysema

Most COPD have both

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2
Q

What is chronic bronchitis?

A

Excessive secretion of bronchial mucus; daily productive cough x 3 months to 2 yrs

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3
Q

What is emphysema?

A

Abnormal permanent enlargement of airspace distal to terminal bronchiole with wall destruction

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4
Q

Is COPD common?

A

Yeah
15 million in us with another approx 15 million as of yet undiagnosed COPD

COPD + asthma = 4th leading cause of death

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5
Q

What is the most common cause of COPD?

A

Smoking

80% have smoking in hx
20% environmental hx

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6
Q

What is the genetic cause of COPD?

A

Alpha-1 antitripsin deficiency

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7
Q

Smoking effects on airways?

A

Hypertrophy and hyperproliferation of mucus glands
Paralysis of cilia
Bronchioles are most affected
-always leads to bronchitis

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8
Q

What effect does smoking have on the lung parenchyma?

A

Destruction of connective tissue matrix making up alveolar walls

A1-antitrypsin imbalance

Leads to parenchyma

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9
Q

What does a1-antirypsin do in the lungs?

A

It inhibits destruction by inhibiting enzymes of inflammatory cells

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10
Q

What is the life expectancy of 1.5 pack/day smoker?

A

65yrs

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11
Q

What are the hereditary factors of COPD?

A

A1-antitrypsin deficiency (AAT) - allows elastin degradation
1% of COPD

Heterozygous (MZ) and Homozygous (ZZ) affects severity

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12
Q

When does COPD develop in those with a1-antitrypsin deficiency?

A

3rd or 4th decade

Check anyone with a fam hx

AAT + tobacco 32-40yrs
AAT w/o tobacco 48-54 yrs

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13
Q

Chronic bronchitis?

A

Enlargement of mucus glands and proliferation of goblet cells
+
Fibrosis = decreased luminal diameber

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14
Q

All Chronic bronchitis is considered what?

A

Considered Mild COPD

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15
Q

Pathology of emyphsema?

A

Destruction of alveolar walls and enlargement of terminal spaces (air trapping)

Loss of elastic recoil -> driving pressure during exhalation

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16
Q

Panacinar emphysema

A

Diffuse involvement of acinus (bronchiole, alveolar ducts, sacs and alveoli)

Lower lung more than upper

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17
Q

Centrilobular emphysema

A

Proximal acinus (bronchiole)

Destruction more irregular with areas of sparred tissue

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18
Q

SS Of COPD?

A

Typically 5th or 6th decade

Early: SOB, cough, sputum production
— 10 yrs
-pink puffer/blue bloater ss emerge

Late: pneumonia, pulm HTN, cor pulmonale, chronic respiratory failure

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19
Q

Hallmark of COPD?

A

Periodic exacerbations

Often precipitated by infection or environment

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20
Q

Bronchitis CC?

A

Chronic productive cough

Daily for 3+ months - 2+ years

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21
Q

Bronchitis PE?

A 
Cyanotic at rest w no distress
Wheezes, rhonchi
Peripheral edema
Multiple lung infections/yr
Mild dypsnea or exercise limitation
Overweight (frequently)
Blue bloaters (hypoxemia)
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22
Q

Emphysema CC?

A

Severe dypsnea

- slow developing w widespread by the time they come in

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23
Q

Emphysema PE?

A 
Rare cough, non-productive 
Thin pt w wt loss
Apparent respiratory distress
Lung sounds quiet
Nonperipheral edema

Pink puffers - hyperventilation

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24
Q

Chronic bronchitis vs emphysema buzz words

A

Bronchitis:

  • cyanosis
  • obesity
  • high Hb (hypoxemia)
  • cough/lung sounds

Emphysema

  • rubor
  • cachexia
  • Older
  • Quiet lungs
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25
PFTs spirometery? Early, mid, late
Early: decreased mid/small airway flow decreased Mild: decreased FEV1 and FEV1/FVC ration Late: very decreased FVC, increased TLC Increased TLC and RV Low DLCO
26
COPD staging
GOLD 1: mild: FEV1 >80% GOLD 2: moderate: FEV1 50-79% GOLD 3: severe: FEV1 30-49% GOLD 4: very severe: FEV1<30%
27
What does the GOLD guidelines assume?
They only look at FEV1 and assume that FEV1/FVC is <70%
28
Do we need areterial blood gas (ABG)study in COPD?
Not routinely needed
29
AVG results for COPD?
If severe chronic broncitis show respiratory acidosis
30
Sputum analysis/culture in COPD?
S. Pneumonia, H. influenzae, M. Catarrhalis Doesnt correlate w exacerbations
31
ECG for COPD?
``` Sinus tach Chronic pulmonary HTN/cor pulmonale Arrhythmias -MAT -A flutter -A fib ```
32
CXR for COPD?
Not for diagnosis only to r/o alternatives/comorbidities
33
Chronic bronchitis x ray results?
Nonspecific peribronchial/perivascular markings Cardiomegaly Increased AP diameter
34
Emphysema CXR results?
Flattening of diaphragms Bullae Peripheral vascular deficiency Relatively small cardiac silhouette Increased AP diameter
35
HRCT for COPD?
High resolution CT Not routinely used Can characterize extent of damage in pts - considered in lobectomy
36
DDx of COPD?
Asthma Bronchiectasis CF Alpha 1 antitrypsin deficiency
37
Complications of stable COPD?
``` Acute bronchitis Pneumonia Pulmonary thromboembolism Atrial dysrhythmias LV failure ```
38
Complications of advanced COPD?
Pulmonary HTN | Cor pulmonale
39
rare COPD complications?
Spontaneous pneumothroax
40
Hemoptysis?
Can be copd (chronic bronchitis) Also may be bronchogenic carcinoma
41
What do COPD pts need to do?
Tobacco cessation Vaccination - influenza - pneumococcal
42
Single most important intervention for COPD?
Smoking Slows the decline in FEV1
43
Resting hypoxemia <90%?
-only therapy w evidence of improvement in natural progression of COPD Longer survival Reduced hospitalizations Improved QOL
44
O2 distribution and rate?
Nasal cannula x 15hrs/day Typically 1-3L/min
45
O2 for COPD with normal/low-normal resting O2 but low O2 w exertion
O2 improves exercise intolerance Shortens recovery from dypsnea NO evidence of mortality benefit
46
What will improve s/s, excercise tolerance and overal health but not the inevitable decline into lung death?
Bronchodilators
47
What inhaled bronchodilators are used?
Short acting: - ipratropium (anticholinergic) - albuterol, metaproterenol (SABAs) Long acting: - tiotropium (LAMA) - Formoterol, salmeterol (LABA) —often combined with ICS
48
What other meds do COPDers get?
corticosteroids - ICS daily for moderate - severe COPD, often combined w LABA - systemic for acute Phosphodiesterase 4 inhibitors - roflumilast - decreased inflammation and increased bronchodilation
49
Who gets ABX?
Most benefit with: -increasted sputum purulence or quantity + dypsnea (think bacterial infection) ``` Pt hx of: Age > 65 FEV1 <50% 3+ exacerbations/yr Comorbitdities (cardiac/DM) ```
50
ABX for COPD exacerbations?
``` Doxycycline 100mg Trimethoprium-sulfamethozazole 160/800mg Cephpodoximine 200mg Azithromycin 500mg Ciprofolaxacin or levofloxacin 500mg Amoxicillin-clavulanate 875/125mg ```
51
What else can help COPD?
Exercise rehab Chest physiotherapy chest wall percussion and drainiage) Supplemental a1-antitrypsin
52
What meds are not helpful for COPD?
Cough suppressants and sedatives | Expectorants/mucolytics
53
When to admit COPD pts?
Acute or worsening symptoms Inadequate home care Inability to sleep/maintain nutrition High risk comorbid conditions
54
Meds the hospital will give to COPD inpatient?
``` O2 titrated 90-94% Ipatropium + SABA Corticosteroids (prednisone 7-10 days) Broad-spectrum abx Chest physiotherapy in selected cases ```
55
Surgical options for COPD?
Lung transplant Lung volume reduction Bullectomy (severe bullous emphysema)
56
Opiates for COPD?
Small amount of opiates can reduce symptoms of air hunger
57
How is the BODE index calculated?
Points accumulated from the following categories: BMI FEV1 Exercise Dypsnea with ___
58
BODE index 4 yr survival rate?
0-2 pts 80% 3-4 pts 67% 5-6 pts 57% 7-10 pts 18%
59
Who gets referred?
``` COPD before age 40 >2 exacerbations/yr on max therapy Severe/rapidly progression S/s disproportionate to severity of airflow obstruction Need for long-term O2 therapy Onset of comorbidities ```
60
Does surgery for COPD extend life?
Nope only palliative, doesnt extend life only improve symptoms

Junior - Pulm Mod 1 (4 decks)

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