COPD Flashcards Preview

ICM -- Pulmonology > COPD > Flashcards

Flashcards in COPD Deck (40):
1

Four types of COPD

Emphysema
Chronic Bronchitis
Refractory Asthma
Severe bronchiectasis

2

What is COPD?

Persistent airflow limitation
Progressive
Associated with enhanced chronic inflammatory response in airways/lung

3

Describe a blue bloater (Chronic Bronchitis)

Overweight + Cyanotic
Elevated Hemoglobin
Peripheral Edema
Ronchi and Weezing

4

Describe a pink puffer (Emphysema)

Older, Thin
Severe Dyspnea
Quiet Chest
CXR shows hyperinflation w/ flattened diaphragm

5

Two mechanisms that underly airflow limitation in COPD

Small Airway Disease
Parenchymal Destruction

6

Manifestations of Small Airway Disease?

Airway inflammation
Airway fibrosis, luminal plugs
Increased Airway Resistance

7

Mechanisms underlying parenchymal destruction in COPD?

Loss of alveolar attachments
Decrease of elastic recoil

8

Risk factors for COPD

Smoking, Occupational Dust/Chemicals, Pollution
Genes, Infections, Socioeconomic Status

9

______ is required for a COPD diagnosis

Spirometry

10

Normal FEV1?
Normal FVC?
Normal FEV1/FVC?

4L
5L
0.8

11

Obstructive disorder. Effect on FVC, FEV1, FEV1/FVC, TLC.

FVC -- normal or down
FEV1 -- Down
FEV1/FVC -- Down
TLC - Normal or Up

12

Restrictive disorder. Effect on FVC, FEV1, FEV1/FVC, TLC.

FVC -- Down
FEV1 -- Down
FEV1/FVC -- Normal to Up
TLC - Down

13

Two indicators of a patient at high risk for exacerbations?

Two or more exacerbation in the last year OR an FEV1 less than half of the predicted value
Also -- history of COPD hospitalizations

14

COPD comorbidities...

CV disease
Osteoporosis
Resp. Infections + Lung Cancer + Bronchiectasis
Anxiety/Depression
Diabetes

15

COPD vs. Asthma. Age

COPD - Older than 35
Asthma -- Any age

16

COPD vs. Asthma. Cough

COPD - Persistent, Productive
Asthma - Intermittent, Unusally nonproductive

17

COPD vs. Asthma. Smoking

COPD - Typical
Asthma - Variable

18

COPD vs. Asthma. Dyspnea

COPD - Progressive, Persistent
Asthma - Variable

19

COPD vs. Asthma. Nocturnal Symptoms.

COPD - Breathlessness late in disease
Asthma - Coughing, Wheezing

20

When do you do alpha-1 antitrypsin deficiency screening?

COPD in Caucasian patients under 45 with strong COPD family history

21

Value of exercise testing in COPD?

Indicator of Health Status Impairment, Predictor of Prognosis

22

Two things proven to increase survival in COPD?

Smoking Cessation and Supplemental Oxygen

23

COPD Stage O. Characteristics and Treatment

Char -- Cough, Sputum. No spirometric abnormalities
No treatment, Discuss smoking cessation

24

Characteristics and Treatment of Mild COPD

Char -- FEV1/FVC under 70
FEV1 over 80% predicted value
Treat w/ short acting bronchodilator as needed

25

Characteristics and Treatment of Moderate COPD

FEV1/FVC under 70
FEV1 betweeen 50 and 80% predicted value
Regular bronchodilators, Rehab, Inhaled Steroids

26

Difference in primary inhaler type for asthma and COPD?

Asthma - beta agonist
COPD - anti cholinergic

27

Characteristics and Treatment of Severe COPD

Ratio under 70, FEV1 btw 30% and 50%
Treat w/ same as moderate (bronchodil., rehab, steroid)

28

Characteristics+Treatment of very severe COPD

ratio under 70, fev1 under 30%
Earlier things + Long term O2 therapy + consider surgical options

29

All COPD patients improve from this non-pharmacological treatment

Exercise training programs

30

Long term administration = ___ hrs/day

more than 15

31

What treatment should possibly supplement Oxygen in patients with pronounced daytime hypercapnia

Noninvasive ventilation

32

What should be considered for patients with upper lobe predominant emphysema?

Lung Volume Reduction Surgery

33

Requirements for Lung Transplant?

6 months smoke free + completed rehab
FEV below 20%
Under 65 y.o.

34

Patient has a PaO2 below 55 and a SaCO2 under 88. Qualifying conditions for long term oxygen therapy?

None required

35

Patient has a PaO2 btw 55-59 and an SaCO2 of 89. Qualifying conditions for long term oxygen therapy?

Polycythemia over 55%
History of edema
P Pulmonale

36

Patient has a PaO2 over 60 and SaCO2 over 90. Qualifying conditions for long term oxygen therapy?

Exercise/Sleep Desaturation uncorreted by CPAP
Lung disease w/ severe dyspnea responding to O2

37

Five important causes of COPD exacerbations

Infections
Pulm. Edema
Pulm. Embolism
Pneumothorax
Non-Compliance

38

When managing COPD exacerbation, oxygen target should be

88-92%

39

Recommended pharmacologic interventions for COPD exacerbation?

Bronchodilators + 40mg prednisone for 5 days

40

Criteria for giving ABs to COPD exacerbation patient

ANTHONISEN CRITERIA
Increased Dyspnea, Increased Sputum Volume, Increased Sputum Purulence

(also those who require ventilation)