COPD

Question 1

COPD

Answer 1

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by airflow limitation; it is usually progressive, not fully reversible, and associated with an abnormal inflammatory response of the lungs.

Question 2

COPD Risks

Answer 2

Genetic
Socioeconomic
Environmental
Behavior

Smoking is the the biggest risk followed by occupational exposure

Question 3

COPD Patho

Answer 3

Alveolar wall destruction likely due to increased activated neutrophils that produce enzymes that destroy elastin in the alveoli. End results in destruction of alveoli architecture and the capillary bed within.

Question 4

COPD Diagnosis

Answer 4

The most common presenting complaints are dyspnea, cough, and/or sputum production. These symptoms are not necessarily noticed by patients until late in the course of this disease, when irreversible changes may have already occurred.

COPD must be considered as a diagnosis in every patient who smokes, even in the absence of respiratory symptoms

Childhood history of bronchitis and history of respiratory problems in childhood is a red flag risk

Question 5

COPD Diagnosis Spirometry

Answer 5

The presence of a post bronchodilator FEV1/FVC of less than 0.70 and FEV1 of less than 80% predicted confirms airflow limitation that is not fully reversible

Question 6

COPD Presentations

Answer 6

Increases A-P chest diameter
Increased intercostal space
Diminished chest excursion
Increased resonance
Right Ventricle enlargement (late)
Spirometry and history are the gold standard for Dx

Question 7

COPD Classification by Severity

Answer 7

Stage 1 - Mild
Stage 2 - Moderate
Stage 3 - Severe
Stage 4 - Very Severe

Question 8

Stage 1 COPD

Answer 8

Mild airflow limitation
FEV1/FVC < 70%, FEV >80%
Chronic cough and sputum production may be present

Question 9

Stage 2 COPD

Answer 9

Progression of symptoms
FEV1 < 80%
SOB with exertion

Question 10

Stage 3 COPD

Answer 10

FEV < 50%
Repeat exacerbations that affect quality of life
Increased SOB

Question 11

Stage 4 COPD

Answer 11

FEV1 < 30%
or FEV1 < 50% with chronic respiratory failure
Quality of life significantly impaired

Question 12

COPD Assessment Test (CAT)

Answer 12

short but comprehensive eight-item measure of health status impairment in patients with COPD

Question 13

Labs in COPD

Answer 13

Elevated HCT and HGB indicate severity of hypoxia

Question 14

COPD v. Asthma

Answer 14

COPD is midlife or later with history of smoking / exposure and progressing symptom; spirometry best does not improve usually with SABAs

Asthma is earlier in life, varying symptoms more common in morning / nights; airflow limits are reversible with SABAs and treatment

Question 15

Oxygen (home) and COPD

Answer 15

PaO2 of 55 or less, SpO2 less than 88% on room air

or

Evidence of right ventricle enlargement or elevated HCT with a PaO2 of 59 or less

Reassess oxygen need every 30 - 90 days

Question 16

Mainstay of COPD Treatment

Answer 16

Anticholinergics and Long acting beta agonists

Question 17

Treatment by Stage

Answer 17

Mild
SABA PRN
LABA if needed

Moderate
LAMA
SABA PRN
LABA+LAMA if needed

Severe
LABA+LAMA+ICS
Stop ICS as soon as able
Oxygen

Question 18

COPD ED Referral

Answer 18

1. Sudden, severe worsening of symptoms with resting dyspnea, ↑ respiratory rate, ↓ oxygen level (pulse ox <90%), confusion
2. Changing or worsening in peripheral edema, cyanosis
3. Failure to respond to treatments
4. History of comorbidities under poor control (e.g., HF, arrhythmias, age, DM)
5. Lack of home support

Question 19

COPD Refer to Pulmonology

Answer 19

1. Severe disease evidenced by persistent dyspnea with activities of daily living and frequent recurrent exacerbations despite therapy.
2. Evaluation for and maintenance of oxygen therapy, including consideration of nocturnal oxygen therapy or transtracheal oxygen therapy.
3. Preoperative assessment for any surgery placing the patient at high risk for pulmonary complications
4. Failure to respond to treatment for an acute exacerbation
5. Consideration of long-term intermittent antibiotic therapy
6. Persistent pulmonary infiltrates on chest radiograph with no response to antibiotic therapy
7. Evaluation of sleep disturbances, including obstructive sleep apnea
8. Management of acute respiratory failure, or if mechanical ventilation is a consideration
9. Cor pulmonale with clinical right-sided heart failure unresponsive to usual therapy
10. Consideration of α1-antitrypsin augmentation therapy

Question 20

COPD Complications

Answer 20

Sleep disorders, acute resp. failure, cor pulmonale

Question 21

GOLD COPD Severity and Symptom Categories

Answer 21

Group A - low symptom severity, low exacerbation risk (LABA or SABA)
Group B - high symptom severity, low exacerbation risk (LABA or LAMA initial or Dual)
Group C - low symptom severity, high exacerbation risk (LAMA or Dual initial, consider LABA+ICS)
Group D - high symptom severity, high exacerbation risk (Dual, add ICS if needed, consider Triple)