COPD Flashcards
1
Q
Three diseases under the umbrella of COPD?
A
Asthma
Chronic bronchitis
Emphysema
2
Q
Emphysema HR&RR?
A
WNL
Increased during exacerbation
3
Q
Emphysema sensorium?
A
Irritable and anxious during severe stage
4
Q
Emphysema body type
A
Thin, underweight
5
Q
Emphysema skin color
A
Reddish
6
Q
Do patients with Emphysema purse lips?
A
Yes. Pursed-lip breathing common
7
Q
Do patients with Emphysema cough?
A
Not common during mild and moderate
Sometimes with infection during severe stage
8
Q
Do patients with emphysema produce sputum?
A
Little
9
Q
Emphysema respiratory patterns
A
Prolonged expiration
Tachypnea
Marked dyspnea (also at rest)
Hypoventilation (late stage)
10
Q
Emphysema neck signs?
A
Nothing seen
11
Q
Emphysema AP diameter?
A
Expanded/barrel chest
12
Q
Emphysema accessory muscles of breathing
A
Used actively, especially during exacerbation
13
Q
Emphysema abdominal muscle use?
A
Yes
14
Q
Emphysema auscultation?
A
Decreased breath sounds and prolonged expiration
Decreased heart sound
15
Q
What is felt with Emphysema chest palpitations?
A
Decrease in tactile fremitus
Decrease in chest expansion
Point of maximal impulse (PMI) often shifts to the epigastric area
16
Q
What is felt with Emphysema abdominal palpitations?
A
Nothing
17
Q
What is heard with Emphysema during chest percussion?
A
Hyperresonance
Decreased diaphragmatic excursion
18
Q
Is there peripheral edema with Emphysema?
A
Uncommon
19
Q
Is there JVD with Emphysema?
A
Uncommon
20
Q
How does the lower lateral chest wall look with Emphysema?
A
“Hoover sign” inward movement during inspiration
21
Q
How does extremities look during Emphysema?
A
Clubbing in late-stage
Yellowed fingertips with smokers
22
Q
HR & RR with Bronchitis?
A
WNL
Tachycardia and tachypnea with exacerbation
23
Q
Sensorium with Bronchitis?
A
Irritable and anxious during moderate and severe stage
24
Q
Body type of bronchitis patients?
A
Stocky and overweight
25
Skin color of patients with Bronchitis?
Cyanotic
26
Lip use during exhaling with Bronchitis?
Not common
27
How often and when do patients with Bronchitis cough?
Often
Especially in the morning
28
What kind of sputum does Bronchitis produce?
A lot of pus like sputum
29
Respiratory Pattern with Bronchitis?
Prolonged expiration
Low RR
30
Neck features with Bronchitis?
JVD
31
Is there an increase in AP diameter with Bronchitis?
Occasionally
32
Is there accessory muscle use with Bronchitis?
Not often, but can be seen in late-stage
33
Is there abdominal muscle use with Bronchitis?
Yes
34
What is heard during auscultation with Bronchitis?
Wheezing
Crackle
Rhonchi
35
What is felt during palpitations of the chest with Bronchitis?
Usually normal
36
What is felt during abdominal palpitations with Bronchitis?
An enlarged tender Liver
37
What is heard during percussion with Bronchitis?
Normal
38
Is there peripheral edema with Bronchitis?
Yes, usually pitting due to right side HF
39
Is there lower lateral chest wall inward movement with Bronchitis?
Hoover sign is uncommon
40
Is there extremity abnormalities with Bronchitis?
Yes
Clubbing
Yellow fingernails with smokers
Pitting edema
41
American Thoracic Society definition of COPD?
A preventable and treatable disease state characterized by airflow limitation that is not fully reversible.
42
What does GOLD stand for?
Global initiative for
obstructive
Lung
Disease
43
What is GOLD’s definition of COPD
A heterogeneous lung condition characterized by respiratory symptoms due to abnormalities AW and/or alveoli that cause persistent, and progressive AW obstruction.
44
What is a key diagnostic feature of COPD?
Persistent and progressive airflow obstruction
airway and or alveoli’s
45
What is the difference between COPD and Asthma?
Asthma is not persistent, reversible
46
Define Chronic Bronchitis?
Clinically defined as chronic productive cough for 3 months in each of 2 successive years
47
How is Chronic Bronchitis diagnosed Clinically
Patients whom other causes have been excluded
48
Define Emphysema?
Pathologically: permanent enlargement of the alveoli with destruction of bronchiole walls
49
What structure undergoes change with Chronic Bronchitis?
Conducting AW
50
What inflammatory mediators cause Chronic Bronchitis?
Leukocytes
51
Describe three significant changes in a patient with Chronic Bronchitis?
Dysplasia/ more inflammatory cells
Less ciliated cells
More mucous glands
More goblet cells
52
GOLD’s GETonmics scheme for the development of COPD over time
Captures how genetics and environment interact over time to become COPD
53
Describe Alpha-1 antitrypsin deficiency influence on the development of Emphysema?
Blocks neutrophil elastase which breakdown connective tissue in the lungs
54
What genetic make-up leads to AP1 deficiency?
Both recessive alleles
(ZZ phenotype)
55
Biggest risk factor to COPD?
Smoking
56
GOLD’s process to diagnosing COPD?
Diagnostic spirometry to confirm (FEV1/FVC <70%)
Grading to determine therapy
57
GOLD COPD clinical indicators present?
Dyspnea
Recurrent wheeze
Chronic cough
Recurrent lower respiratory tract infection
History of risk factors
58
COPD Dyspnea characteristics?
Progressive over time
Worse with exercise
Persist
59
COPD chronic cough characteristics?
May be intermittent and unproductive
60
Risk factors that can lead to COPD?
Tobacco smoke
Smoke: from cooking and heating fuels
Occupational: dust, vapor, fumes, gases, and other chemicals
Host factors: genes, developmental abnormalities, low birthweight, prematurity, childhood respiratory infection
61
How does a COPD spectrogram look?
Flow is abnormally low
62
GOLD 1/ mild: FEV1/FVC
FEV1 > or equal 80% predicted
63
GOLD 2/ Moderate: FEV1/FVC
50%< FEV1 <80% predicted
64
GOLD 3/ severe: FEV1/FVC
30% < FEV1 <50% predicted
65
GOLD 4/ very severe: FEV1/FVC
FEV1 < 30% predicted
66
Issues with GOLD COPD grading outcome?
Combined assessment scheme is good for a population but not good for individual
67
How does GOLD overcome the BMI hurdle?
Has a second categorization based on symptoms and risk (A,B,E)
68
Criteria for “E”
> or equal 2 moderate exacerbations or > or equal to 1 hospitalization
69
CAT score for grade “A”
<10
70
CAT score for grade “B”
> or equal to 10
71
What is a modified MRC dyspnea scale?
An assessment done in collaboration with the CAT assessment to use on the A,B,E scale
72
What is the CAT assessment?
An assessment done along with a MRC assessment to find A,B,E grade
73
“I only get breathless with strenuous exercise” MRC grade?
0
74
“I get short of breath when hurrying on the level or walking up a sight hill” MRC Grade
Grade 1
75
“I walk slower than people of the same age on level because of dyspnea. Have to stop walking (MRC grading?)
Grade 2
76
“I stop for breath after walking about 100 meters or after a few minutes” (MRC grading?)
Grade 3
77
“I am too breathless to leave the house or when dressing or undressing” (MRC grading?)
Grade 4
78
COPD pattern of respiratory symptoms?
Present despite treatment
Good and bad day though daily exertion
Chronic cough and sputum unrelated to triggers
79
Age of onset of COPD?
After 40 years old
80
Lung Function of COPD?
Persistent airflow limitation (post bronchodilator)
81
COPD past diagnosis?
Doctor diagnosis
Heavy exposure to tobacco smoke, biomass fuels
82
Chest X-ray for COPD?
Severe Hyperinflation
83
Time course for COPD?
Slowly worsens over time
Rapid-acting bronchodilator has minimal relief
84
What is a DLCO test?
Identifies disorders of diffusion capacity of the lung by see how carbon monoxide crosses
85
Why is DLCO useful for identifying COPD?
Patients with Emphysema have low surface area so diffusion is low
86
Emphysema Hct & Hgb levels?
Normal during mild and moderate stage
Elevated during late stage
87
Chronic Bronchitis Hct & Hgb levels?
Elevated throughout disease state
88
Circular steps for COPD treatment?
Diagnosis
Initial assessment
Initial management
Review
Adjust
89
What are GOLD’s goals for treatment?
Reduce symptoms and reduce risk of exacerbation
90
Name non-pharmaceutical management?
Smoking cessation
Vaccination
Active lifestyle and exercise
Self management education
Manage cormorbidities
91
What is smoke cessation?
Nicotine replacement.
Legislative smoking bans and counseling
92
How does vaccination aid in COPD management?
Protects patients against infections limiting exacerbations
93
Factors under self management?
Risk factor management
Inhaler technique
Breathlessness
Written action plan
94
What medication should patients in group “A” take?
A bronchodilator
95
What medication should patients in group “B” take?
LABA+LAMA
96
What medication should patients in group “E” take?
LABA+LAMA
Consider including a ICS if the eosinophil level is above 300
97
How do you choose medications within class?
Availability and cost
Favorable clinical response
side effects
98
Symptoms that STRONGLY favor ICS?
History of hospitalizations
2 or more exacerbation per year
Eosinophil level 300 or more
History of or concomitant asthma
99
Symptoms that favor uses of ICS
1 moderate exacerbation
Eosinophil levels between 100-300 cells/um
100
Symptoms against use of ICS?
Repeated pneumonia events
Eosinophil levels lower than 100 cells/um
History of mycobacteria infection
101
Patient focused consideration for inhaled medication
Price
Technique
Reassessing
Patients preference
102
Consideration when giving oxygen therapy?
Patients with stable COPD and desaturation during moderate resting and exercise are not saved from hospitalization, lung function and 6 minute walk
BiPAP May reduce risk of hospitalization especially thoughts with hypercapnia
103
GOLD’s definition of NPPV after recent hospitalization?
BiPAP May improve risk of hospitalization survival after hospitalization
especially those with daytime hypercapnia
104
define COPD exacerbation?
An event characterized by increased dyspnea, cough and sputum worsening in less than 14 days
Can include tachycardia and tachypnea also associated with local and systemic inflammation caused by infection, pollution etc.
105
What should be ruled out before COPD diagnosis?
Pneumonia
Pulmonary embolism
Heart failure
106
What should be ruled out before COPD diagnosis?
Pneumonia
Pulmonary embolism
Heart failure
107
Alleles for alpha-1 antitrypsin deficiency?
ZZ
108
Relationship between chronic bronchitis and emphysema?
Chronic bronchitis can raise the risk of emphysema
109
Does it take longer for someone with COPD to exhale there FVC?
Yes
110
Why is spirometry grading 1,2,3,4 not good for individual?
Not very precise but good for population
111
Simplified GOLD track to diagnosis?
Spirometrically confirm diagnosis
Assessment of airflow obstruction
Assessment of symptoms/risk of exacerbation
112
Why does COPD cause polycythemia?
Less O2 diffusion, more RBCs to compensate
113
Name the four key treatments for COPD
Bronchodilator
Steroids
Antibiotics
Noninvasive ventilation(preferred)
114
GOLDs definition of exacerbation
Increase in dyspnea and cough and sputum that worsens in less than 14 days
RR&HR⬆️
115
How many people in U.S. have alpha1-antitrypsin deficiency?
80,000-100,000
