Lecture 12 COPD

Question 1

COPD:
____ decreases dramatically;
FVC _____;
What happens to the ratio?

Answer 1

FEV1; decreases;

Ratio decreases

Question 2

Is COPD due to obstruction of inflow or obstruction of outflow?

Answer 2

outflow

Question 3

Bronchitis vs Emphysema:
patients are overweight and cyanotic = 
patients are older and thin = 
Peripheral edema is common = 
Increased AP diameter of chest =

Answer 3

bronchitis (blue bloater);
emphysema (pink puffer);
bronchitis;
emphysema

Question 4

COPD:
____ lose their shape and become clogged with mucus;
walls of ____ are destroyed.

Answer 4

bronchioles;

alveoli

Question 5

bronchitis vs emphysema:
enlargement of air spaces =
loss of elastic recoil =
hyperplasia of mucus secreting glands = 
barrel shaped chest =

Answer 5

emph;
emph;
bronch;
emph

Question 6

90% of patients with COPD are ____

Answer 6

smokers

Question 7

what is required to establish diagnosis of COPD?

Answer 7

spirometry

Question 8

What spirometric finding tells you how severe the COPD is?

Answer 8

FEV1; ie more decreased FEV1 = more severe disease

Question 9

COPD vs asthma:
which is reversible?
persistent and productive cough seen in =

Answer 9

asthma;

COPD

Question 10

what genetic deficiency should be screened for in patients with COPD of a young age?

Answer 10

alpha 1 antitrypsin

Question 11

CXR of patient with COPD shows a ____ diaphragm

Answer 11

flattened

Question 12

most important therapeutic option in treating COPD

Answer 12

smoking cessation

Question 13

2 autonomic drugs used in treatment of COPD

Answer 13

beta 2 agonists, anticholinergics

Question 14

____ corticosteroids are used in short term inhalers. ____ corticosteroids are used during periods of COPD exacerbation.

Answer 14

inhaled;

systemic

Question 15

_____ inhibitors are specifically used in bronchitis patients

Answer 15

phosphodiesterase-4

Question 16

what treatment is recommended at all stages of COPD?

Answer 16

exercise rehab

Question 17

exercise rehab helps with improvements in _____ tolerance and symptoms of ____ and ____

Answer 17

exercise; dyspnea, fatigue

e.g. breaks the “spiral of disability/deconditioning”

Question 18

what COPD treatment has been shown to increase survival in patients with severe, resting hypoxemia?

Answer 18

oxygen therapy (at least 15 hours a day)

Question 19

non-invasive ventilatory support should be used in patients with pronounced day-time _____

Answer 19

hypercapnia (ie increased CO2)

Question 20

Lung volume reduction surgery (LVRS) is more efficacious in patients with ____-lobe _____ and low _____ capacity

Answer 20

upper, emphysema;

exercise

Question 21

what is indicated in patients with a PaO2 less than 55 and a SaO2 less than 88%?

Answer 21

long term oxygen therapy

Question 22

what is “P” pulmonale?

Answer 22

tall peaked P waves;

indicates R. atrial enlargement

Question 23

most common cause of exacerbation of COPD?

Answer 23

infection.

also edema, PE, pneumothorax, non-compliance

Question 24

in patients with COPD exacerbation, ____, ____, or bleeding may be present on whole blood count

Answer 24

anemia, polycythemia (due to decreased O2)

Question 25

what kind of test is not recommended during COPD exacerbation?

Answer 25

spirometric

Question 26

What is the target saturation of oxygen for treatment of patients with COPD exacerbation? Why not higher?

Answer 26

88-92;

want to avoid CO2 narcosis

Question 27

3 cardinal symptoms of bacterial COPD exacerbation (anthonisen criteria):

Answer 27

increased dyspnea, increased sputum volume, increased sputum purulence

antibiotics should be given

Question 28

2 other indicators that antiobiotics should be given to a patient with COPD exacerbation:

Answer 28

mechanical ventilation; CXR indicative of pneumonia

Question 29

nicotine is _____ but does not cause _____

Answer 29

addictive, lung damage

Question 30

by ____ years after quitting smoking, all cause mortality falls to levels of a never-smoker

Answer 30

15

Question 31

5 A’s approach to talking about quitting smoking with a patient

Answer 31

ask, assess, advise, assist, arrange

Question 32

2 prescription medicines approved for cessation of tobacco usage

Answer 32

bupropion, varenicline

Question 33

besides prescription meds, what is the other general type of pharmacotherapy?

Answer 33

nicotine-replacement therapy ie patch or gum

Question 34

mechanism of action of bupropion

Answer 34

NE and dopamine reuptake inhibitor

Question 35

mechanism of action of varenicline

Answer 35

nicotine receptor partial agonist

Question 36

do anticholinergics work better in treatment of asthma or COPD?

Answer 36

COPD (not v effective in asthma)