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COPD Flashcards

1
Q

conditions that make it hard to exhale all of the air in the lungs

A

Obstructive lung disease

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2
Q

how many people does COPD affect in the US?

A

32 million

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3
Q

what # cause of death in the US?

A

4th

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4
Q

triad of COPD

A

chronic bronchitis
emphysema
asthma

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5
Q

chronic bronchitis definition

A

chronic inflammation and thickening of the walls of the bronchial tubes with excess mucus

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6
Q

emphysema definition

A

abnormal, permanent enlargement of air spaces distal to terminal bronchioles accompanied by destruction of their walls and without obvious fibrosis

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7
Q

when does COPD start?

A

later in adulthood (40s), worsens with age

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8
Q

when does asthma start?

A

childhood, does not worsen with age

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9
Q

what triggers COPD

A 
smoking
inhaled fumes
pollution
dusts
chemicals
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10
Q

what triggers asthma

A

allergens
weather
heredity

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11
Q

symptom pattern of asthma

A

symptom-free between attacks

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12
Q

symptom pattern of COPD

A

chronic, occurring all of the time

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13
Q

airflow restoration in asthma

A

can be treated and quickly restored

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14
Q

airflow restoration in COPD

A

some airflow can be restored by quitting smoking and taking prescribed meds

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15
Q

three main issues of COPD

A

airway inflammation
mucociliary dysfunction
airway structural changes

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16
Q

biggest culprit of COPD

A

smoking

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17
Q

other causes of COPD

A 
environmental factors
airway hyerresponsiveness
alpha1-antitrypsin deficiency
IVDA
HIV
GERD
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18
Q

environmental factors contributing to COPD

A

air pollution
chemical fumes
dust
second hand smoke

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19
Q

airway hyperresponsiveness is characterized by

A

easily triggered bronchospasm

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20
Q

how do we assess airway hyperresponsiveness

A

bronchial challenge test with methacholine or histamine

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21
Q

how does the bronchial challenge test work?

A

blow an irritant at the pt and see their response to it before treating them

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22
Q

when do we use a bronchial challenge test?

A

when spirometry test is not conclusive

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23
Q

what pathologies do we see airway hyperresponsiveness in?

A

asthma

COPD

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24
Q

what is the genetic predisposition to COPD

A

alpha1-antitrypsin deficiency (AAT)

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25
how is AAT inherited
autosomal co-dominant
26
pathophys behind AAT deficiency
lack of protein released from liver that protects lung parenchyma from elastolytic breakdown
27
what other pathology do we see AAT issues with?
liver issues
28
what patient population do we see AAT in?
younger patients (around 26)
29
what should we do if we suspect AAT?
bloodwork!
30
how many IV drug users get emphysema?
2%
31
how does IVDU result in COPD?
pulmonary vascular damage due to insoluble fiber (such as talc, cornstarch, cotton fibers, and cellulose) in IV drugs
32
what HIV population is it common to see COPD in?
those with CD4 counts >500
33
how many HIV pts have COPD?
23%
34
what is the most common non-infectious pulmonary disease amongst HIV pts?
COPD
35
what GI pathology exacerbates COPD?
GERD
36
how many COPD patients have GERD?
28%
37
what is presence of COPD and GERD associated with?
increased risk of hospitalization
38
when does DOE occur in COPD?
in 6th decade | by the time FEV1 is less than 50% normal
39
most common variable to grade COPD severity
FEV1
40
what kind of cough do COPDers have?
productive cough | worse in AM
41
3 general symptoms of COPD
productive cough acute chest illness wheezing (especially with exertion)
42
best single predictor of an airflow obstruction?
history of >40 pack-years of smoking
43
PE findings for COPD
``` respiratory rate (increases with severity) increased JVP cyanosis accessory muscle use barrel chest decreased breath sounds distant heart sounds hyperresonance prolonged expiration coarse crackles on inspiration peripheral edema ```
44
term for accessory muscle use
hoover sign
45
why does a hoover sign occur?
flattened diaphragm
46
describe a "blue bloater
``` obese frequent cough/expectoration accessory muscle use coarse rhonchi wheezing right sided heart failure symtoms (edema, cyanosis) ```
47
how advanced are blue bloater's COPD
end stage
48
describe a pink puffer
``` thin barrel chest little-no cough/expectoration pursed lips accessory muscle use tripod hyperresonant wheezing distant heart sounds ```
49
what is the FEV1/FVC level for COPD?
<70%
50
what determines how effectively gases are exchanged between the blood and airways in the lungs?
diffusion lung capacity with CO (DLCO)
51
how do they test DLCO?
put pt in a glass box and blow CO at them to assess diffusion pt inhales CO, helium, and O2 and holds breath for 10 seconds gas levels analyzed from exhaled breath
52
pCO2, pH, and HCT relative levels with COPD DLCO
increased CO2 decreased pH increased HCT
53
why is HCT increased in COPD?
body's response to not having enough oxygen | overcompensates by creating more RBC
54
Xray findings in COPD
low flattened diaphragm hyperinflation increased AP retrosternal airspace narrow cardiac silhouette
55
what happens in small airway disease in COPD?
airway inflammation and remodeling
56
what happens in parenchymal destruction in COPD?
loss of alveolar attachments | decrease of elastic recoil
57
what causes small airway disease and parenchymal destruction?
inflammation
58
what does small airway disease and parenchymal destruction cause?
airflow limitation
59
what does the GOLD criteria stand for?
global initiative for chronic obstructive lung disease
60
who contributes to the GOLD criteria?
NIH and WHO
61
3 criteria areas for GOLD
symptoms (based on modifed medical research council (mMRC) or COPD assessment test (CAT) airflow obstruction (FEV1) exacerbation hx
62
relative difficulty and scale for mMRC questionaire?
easy (1 question) | grade 0-4
63
COPD assessment test format
rate a few questions 0-5
64
how do we ultimately want to classify COPD patients based on their severity?
category A-D
65
MOA of SABA
beta2 agonist relaxes bronchial smooth muscle inhibits release of immediate hypersensitivity mediators from mast cells
66
indications for SABAs
adults and kinds COPD Acute asthma exacerbations exercise-induced asthma prophylaxis
67
drug interactions of SABAs
beta blockers
68
adverse effects of SABAs
``` tachycardia URI Nausea Pharyngitis **a-fib **hypokalemia ```
69
generic for SABA
albuterol
70
brand names for SABA
ventolin, proventil
71
pregnancy category of SABAs
C
72
clinical teaching of SABA
``` warn of side effects proper inhalation rinse wash mouthpiece if used > 2x/week consider controller therapy ```
73
SAMA MOA
anti-cholinergic effects suppresses tightening of bronchial smooth muscle anti-secretory properties
74
indications of SAMAs
adults and kids COPD asthma exacerbation allergic rhinitis
75
adverse effects of SAMAs
``` headache URI bronchitis xerostomia dry nasal mucosa **bronchospasm **anaphylaxis **glaucoma ```
76
what med is often mixed with albuterol (to make duoneb)
SAMAs
77
generic SAMA
ipratropium
78
brand SAMA
atrovent HFA (MDI)
79
pregnancy category of SAMA
B
80
clinical teaching for SAMAs
avoid activities requireing mental alertness or coordination --> dizziness improvements from nasal spray may be delayed proper inhalation technique
81
SABA + SAMA MOA
beta2 agonist and anti-cholinergic effects suppresses tightening of bronchial smooth muscle anti-secretory properties
82
indications for SABA+SAMA
adults and kids COPD asthma exacerbation
83
adverse effects of SABAs+SAMAs
``` headache URI **bronchospasm **anaphylaxis **hypokalemia ```
84
generic of SABA + SAMA
albuterol/ipratroprium
85
brands of SABA+SAMA
combivent (MDI) | DuoNeb (neb)
86
pregnancy category of SABA+SAMA
B
87
clinical teaching for SABA+SAMA
avoid activities requiring mental alertness/coordination improvments from nasal spray possibly delayed proper inhalation technique
88
LABA MOA
beta2 agonist | relaxes bronchial smooth muscle and inhibits release of immediate hypersitivity mediators from mast cells
89
indications for LABAs
COPD asthma exercise-induced asthma prophylaxis
90
what class drug reduces need for rescue medications by 21%
LABAs
91
what class drug has the black box warning of increased risk for asthma related death, intubation, or hospitalization in ages 4-11 but not when combnined with an inhaled steroid
LABA
92
adverse effects of LABAs
``` HA musculoskeletal pain **death **prolonged QT **asthma exacerbations ```
93
generics of LABAs
salmeterol | formoterol
94
salmeterol brand
serevent (LABA)
95
formoterol brand
foradil (LABA)
96
pregnancy category of LABA
C
97
clinical teaching of LABAs
not for acute exacerbation adverse effects inhalation technique
98
LAMA MOA
anti-cholinergic effects suppresses tightening of bronchial smooth muscle anti-secretory properties
99
indications of LAMAs
COPD
100
adverse effects of LAMAs
``` URI xerostomia bronchitis constibation **bowel obstruction **bronchospasm **glaucoma ```
101
generic of LAMA
tiotropium
102
brand of tiotropium
Spiriva (LAMA)
103
pregnancy category of LAMAs
C
104
clinical teaching of LAMAs
avoid activities requiring mental alertness or coordination improvements may be delayed proper inhalation technique
105
LAMA + LABA MOA
anti-cholinergic and LABA
106
indications of LAMA+LABA
COPD
107
adverse effects of LAMA+LABA
``` pharyngitis diarrhea extremity pain **asthma related death **anaphylaxis **HTN **hypokalemia **prolonged QT ```
108
generic of LAMA + LABA
umeclidium/vilanterol
109
umeclidium/vilanterol brand
anoro ellipta
110
pregnancy category of LAMA+LABA
C
111
clinical teaching of LAMA+LABA
if using other inhalers, use at least another minute before using another
112
ICS+LABA MOA
beta2 agonist relaxes bronchial smooth muscle and inhibits release of immediate hypersensitivity mediatorys from mast cells mimics cortisol with salt-retaining properties
113
indications for ICS+LABA
adults and kids COPD asthma
114
adverse effects of ICS+LABA
``` oral candidiasis GI upset HA nasopharyngitis URI **hypokalemia **glaucoma **cataracts **asthma related death ```
115
generic of ICS + LABA
formoterol/budesonide salmeterol/fluticasone formoterol/mometasone
116
brand of formoterol/budesonide
symbicort (ICS+LABA)
117
`brand of salmeterol/fluticasone
advair (ICS+LABA)
118
brand of formoterol/mometasone
dulera (ICS+LABA)
119
pregnancy category of ICS+LABA
C
120
clinical teaching of ICS+LABA
``` not indicated for acute reduced growth rate in kids adrenal supression rinse mouth oral infections ```
121
MOA of PED4i
reduces neutrophil and eosinophil counds in lungs
122
PDE4i stands for
phosphodiesterase-4 inhibitor
123
indications for PDE4i
COPD (chronic, exacerbation, prophylaxis)
124
adverse effects of PDE4i
``` weight loss GI upset influenza back ache dizziness HA insomnia **suicidal thoughts ```
125
generic of PED4 i
roflumilast
126
roflumilast brand
daliresp (PDE4i)
127
pregnancy category of PDE4i
C
128
clincial teaching for PDE4i
not for acute bronchospasm warn SE report weight loss report depression, anxiety, suicidal ideation, unusual changes in behavior
129
theophylline MOA
bronchodilation through smooth muscle relaxation | suppression of airway stimuli
130
class of theophylline
methylxanthene
131
indications of theophylline
COPD asthma exacerbation asthma newborn apnea
132
adverse effects of theophylline
``` nausea vomiting HA insomnia restlessness irritability **a-fib **stevens-johnson **seizures ```
133
brand of theophylline
theo-dur
134
pregnancy category of theophylline
C
135
clinical teaching of theophylline
not for acute exacerbations | theophylline toxicity
136
symptoms of theophylline toxicity
vomitting arrhythmia seizures
137
COPD complications
``` respiratory infections pulmonary HTN increased risk of heart disease GERD lung CA depression ```
138
what happens to FEV1 with smoking cessation
rate of decline is slowed
139
what reduces the frequency of the common cold which triggers COPD exacerbations?
PPIs
140
when do we give O2 therapy to COPDers?
when chonically hypoxic | resting O2 <90%
141
which vaccination should all COPD pts have?
influenza
142
which vaccination should COPDers >65 have?
pneumococcal
143
how good is AAT treatment?
questional benefit
144
what can reduce dyspnea in selected pts?
bullectomy
145
what surgeries can be done for COPD?
lung volume reduction surgery | lung transplant
146
is surgery common for COPD?
no
147
chronic infections in COPD
S. pneumonia M. catarrhalis H. influenza
148
severe infections in COPD
p. aeruginosa
149
what should we consider with COPD pts and infections?
have a low threshold for treating them because they are more prone
150
what does airtrapping look like on CXR
hyperlucency (black)
151
reliever meds for COPD
SABAs
152
controller meds for COPD
LABAs
153
preventer meds for COPD
inhaled corticosteroids
154
definition of bronchiectasis
abnormal, permanent dilation/destruction of bronchi walls where mucous pools
155
who is bronchiectasis more common in?
slender white women >60
156
what is lady windermere's syndrome?
bronchiectasis
157
what infection did lady windermere die from?
M. avium (MAC)
158
what is an important cause of lung disease in developing countries?
bronchiectasis
159
what deficiency is common in bronchiectasis
vitamin D
160
what is vitamin D deficiency a marker of
disease severity
161
what are vitamin D deficient bronchiectasis patients more commonly colonized with?
pseudomonas aeruginosa
162
what bronchi are most affected by bronchiectasis
proximal and medium sized
163
is dilation of the bronchi focal or diffuse in bronchiectasis
either
164
how does one get bronchiectasis?
acquired (more common) | congenital
165
causes of bronchiectasis
``` congenital infection airway obstruction impaired drainage toxic gas exposure CF ```
166
what do affected bronchi show in bronchiectasis?
transmural inflammation mucosal edema craters ulcers
167
causes of infection in bronchiectasis
``` S. pneumonia (most common) S. aureus H. influenza M. tuberculosis P. aeruginosa M. avium M.catarrhalis RSV ```
168
what causes airway obstruction in bronchiectasis?
foreign body aspiration due to altered mental status or GERD | stroke patients because they cannot protect their airway
169
impaired drainage with bronchiectasis caused by
CF primary ciliary dyskinesia allergic bronchopulmonary aspergillosis (ABPA)-fungal infection
170
toxic gas exposure in bronchiectasis caused by
chlorine (water disinfectant) | ammonia (used in fertilizer, refrigerants, cleaning solutions)
171
what caused 1/3 of bronchiectasis
CF
172
clinical manifestations of bronchiectasis
``` cough mucopurulent sputum production lasts months-years blood-streaked sputum or hemoptysis little or no sputum can be a sequela of TB ```
173
what is bronchiectasis hard to differentiate from?
COPD
174
non-specific bronchiectasis symptoms
dyspnea pleuritic chest pain wheezing fever
175
specific symptoms to bronchiectasis
weakness | weight loss
176
non specific physican exam findings for bronchiectasis
``` crackles rhonchi wheezing inspiratory squeaks cyanosis ```
177
specific bronchiectasis physical exam findings
digital clubbing wasting weight loss
178
what do you make the bronchiectasis diagnosis based off of
clinical presentation sputum analysis high-resolution CT (confirmatory)
179
how do we often control infections in bronchiectasis
fluoroquinolones
180
how do we reduce inflammation in bronchiectasis
beta agonists anti-cholinergics ICS
181
how do we improve bronchial hygiene
airway mucous clearance- | chest percussion and postural drainage
182
CF definition
disease of exocrine gland causing production of abnormally thick mucus, leading to blockage of bronchi, pancreatic ducts, and intestines
183
how is CF inherited
autosomal recessive | chromosome 7
184
what is the most common lethal hereditary disease in the white population
CF
185
median age of CF dx
6-8 months
186
median survival age for CF
41
187
how many live births are affected with CF
1/3000
188
what is the genetic defect of CF
defect in CF gene (protein transmembrane conductance regulator (CFTR)
189
how many mutations are possible in CF
>1500
190
what is missing in CF
missing the gene so it doesn't move the chloride ions out and mucous becomes sticky
191
what ions are increased/decreased in CF
decreased secretion of chloride | increased reasborption of sodium and water
192
what other secretions are affected in CF
respiratory tract pancreas GI tract sweat glands have increased viscosity
193
clinical manifestations of CF
``` severe lung disease pancreatic insufficiency nasal polyposis sinus disease meconium ileus rectal prolapse chronic diarrhea pancreatitis cholelithiasis cirrhosis ```
194
CF PE findings
``` rhinitis nasal polyps cough tachypnea respiratory distress with retractions wheezes, crackles increased AP chest diameter clubbing cyanosis hyperresonace ```
195
what kind of cough to CF pts have?
worse at night and upon awakening | viscous, purulent, green sputum
196
GI PE findings for CF
``` abd distention hepatosplenomegaly (portal HTN) rectal prolapse dry skin (vit A deficiency) cheilosis (vit B deficiency) swelling of submandibular or parotid gland aquagenic wrinkling of palms ```
197
male urogenital PE for CF
undescended testicles hydrocele absence of vas deferens
198
what percent of CF men are sterile
>95%
199
female urogenital PE findings for CF
severe nutritional deficiency --> amenorrhea
200
what percent of CF female are sterile?
20%
201
what too abnormalities does vitamin D deficiency cause in CF?
scoliosis and kyphosis
202
how does CF affect the nose?
sinusitis due to obstruction of sinus ostia
203
what occurs from inflammation of pulmonary vessels in CF
hemoptysis
204
what occurs from rutpured alveoli in CF
pneumothorax
205
what effects does CF have on the GI tract?
pancreatic insufficiency diabetes (decreased flow from pancreatic duct) cholithiasis (decreased bile flow = sludge)
206
other effects on the body from CF
weak muscles due to malabsorption | stress incontinence due to decreased strength of pelvic floor muscles)
207
diagnosis of CF
``` postive sweat chloride test or positive genetic test AND one of the following COPD documented pancreatic insufficiency positive family history ```
208
what imaging should we do for CF
initially CXR then consider CT
209
primary goals of treatment for CF
maintain lung function administer nutritional therapy to maintain adequate growth manage complications with supplements and vaccines
210
how do we clear the airways of mucus for CF patients?
bronchodilator before chest physiotherapy | mucolytic- dornase alpha (pulmozyme) + hypertonic saline solution aerosols
211
what vitamins/ supplements do CF patients need?
vitamins (ADEK)-fat soluble pancreatic enzymes high energy, high fat diet
212
how may we manage diabetes CF complications?
insulin
213
how may we manage pneumothorax CF complications?
chest tube
214
will CF patients get nasal polys?
yes --> polypectomy
215
what GI complications may we have to treat for CF?
ileus prolapse gastrotomy tube for supplemental feeding
216
other treatment for CF
CFTR potentiators
217
MOA of CFTR potentiators
target defective CFTR protein
218
indication for CFTR potentiators
patients with IG551D mutation
219
generic of CFTR potentiator
ivacaftor
220
brand for ivacaftor
Kalydeco (CFTR potentiator)

CMPP (17 decks)

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