chronic obstructive diseases Flashcards
(53 cards)
When does lung function decline in COPD?
after age 40 with presence in the 50s and 60s and progressing
What do these symptoms characterize: cough, sputum production, SOB that starts w/ exertion, common to see blue bloaters and pink puffers?
COPD
What are risk factors for COPD?
History of smoking or biomass fuel cooking, air pollution, airway infection, environmental factors, allergy, hereditary factors, reactive airway disease
Exposures early in life → poor lung growth in childhood + expiratory flow limitation (may not manifest clinically until mid-life)
Is COPD reversible?
no
How are COPD exacerbations precipitated?
infection or exposure
What do late stages of COPD look like?
pneumonia, pulmonary HTN, RHF, chronic respiratory failure
What deficiency can predispose someone to emphysemic dysfunction and COPD and is common in 20yo with early unexplained disease that may be misdiagnosed as asthma with no improvement upon treatment + unexplained pannicultis + antiproteinase-3 vasculitis?
alpha 1 antitrypsin deficiency
What is the treatment for alpha 1 antitrypsin deficiency?
augmentation therapy
What would this PE indicate:
barrel chest -> lungs fill w/ air + unable to fully breathe out
- use of resp muscles
- pursed lip breathing
- reduced chest expansion
- reduced breath sounds
- wheezing
- hyperresonance
- expiratory time >4s
- reduced expiratory flow, airflow obstruction, air trapping + hyperinflation?
COPD
What is the basis of COPD diagnosis?
spirometry
What on an early PFT would indicate COPD?
abnormal closing volume
What on FEV1 and FEV1/vital capacity indicate COPD?
reduced –> airflow obstruction
severe = significant FVC reduction
What does an increase in residual volume + total lung capacity or elevation of RV/TLC ratio mean?
COPD – air trapping + hyperinflation
What tests do you need to indicate COPD?
DLCO (effectiveness), 6 minute walk test, ABGs (w/ hypoxemia or hypercapnia), FEV1 or DLCO <40% of predicted for severe COPD and <70% meaning obstruction
early sign could be increased alveolar-arterial gradient
respiratory acidosis
sinus tachy
chest xray to differentiate chronic bronchitis and emphyema
What’s the first line for COPD?
smoking cessation and vaccination
How do you identify a high risk patient?
1) FEV1<50% of predicted
2) 2+ exacerbations in past year
3) 1+ hospitalizations for COPD exacerbations in the past year
What’s the gold criteria?
FEV1 measurement
Gold 1 - >80 - mild
Gold 2 - 50-79 - moderate
Gold 3 - 30-49 - severe
Gold 4 - <30 - very severe
<70 needs treatment
Group A/B- 1 or 2
Group E - 3 or 4
What group of medications do you give for a patient with more than 2 moderate exacerbations or more than 1 leading to a hospitalization?
Group E- (LAMA + LABA for highly symptomatic or ICS + LABA + LAMA for eos >300) + SAMA or SABA
What group of medications do you give for 0-1 exacerbations with no hospital admission?
Group A (bronchodilator) or B (long acting bronchodilator)
Group A
bronchodilator (SAMA or SABA) short acting
Group B
LABA AND LAMA
Group E
LAMA+LABA (highly symptomatic) or ICS + LABA + LAMA (eos>300) + SABA/SAMA
How do you treat COPD outpatient?
O2 for at least 15 hours a day and only treatment to lengthen life
What medications can you use to improve symptoms in COPD?
inhaled bronchodilators but stop if doesn’t help
