Flashcards in COPD Deck (64):
What is COPD?
An obstructive pulmonary disease, characterized by airflow limitation that is not fully reversible, and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases
What is the difference between COPD and asthma?
Asthma is reversible
What percent of the US population has COPD?
What is the typical COPD pt?
65+ poor white woman that smokes
What are the risk factors for COPD?
What are the three characteristics of the small airway disease underlying COPD?
Parenchymal destruction in COPD results in what two major effects?
-Loss of alveolar attachments
-Decrease of elastic recoil
What is the definition of chronic bronchitis?
Productive cough that occurs everyday for at least 3 months, two years in a row
What are the three COPD subsets?
What are the ssx of COPD? How fast is the onset?
What are the physical findings late in the course of COPD? (3)
-Using accessory muscles at rest
-Increased AP diameter
What happens with FEV1 and FEV1/FVC with COPD patients?
Decreased FEV1, and lower FEV1/FVC (less than 0.7)
What are the four steps of assessing COPD?
1. Assess symptoms
2. Assess severity by spirometry
Is the cough associated with COPD usually productive?
No, but may be variable from day-to-day
What are the characteristics of dyspnea with COPD?
Progressive, worse with exercise
What are the post bronchodilator FEV1 percentages for mild, moderate, severe, and very severe COPD?
mild = more than 80%
moderate = 50-80%
severe = 30-50%
Very severe = less than 30%
What happens to the flow-volume loop with obstructive lung disease?
Indentation of the curve
What are the two main predictors of exacerbation risk for a patient with COPD?
-Two or more exacerbations within the last year, or
-an FEV1 less than 50%
True or false: any hospitalization for COPD exacerbations should be considered a high risk pt
What are the comorbidities with COPD?
What is bronchiectasis?
Chronic inflammation of the airway leading to fibrotic changes, and impaired mucus clearance
What are the two main goals of therapy for COPD?
What is the single most important intervention for COPD?
How much faster do your lungs age with smoking?
True or false: there is still benefit of smoking cessation at age 65
What medications have been should to modify long term decline of lung function with COPD?
What are the goals of pharmacotherapy with COPD?
Decrease ssx and complications
What are the beta agonists used to treat COPD?
What is the major anticholinergic used to treat COPD?
What is the MOA of theophylline?
PDE inhibitors to Increase cAMP to induce bronchodilation
What are the major issues of theophylline use?
Narrow therapeutic index
What are the 5 long acting bronchodilators?
What are the four major muscarinic long acting bronchodilators?
When are corticosteroids used for COPD?
Used in combination of LABA or LAMA for severe obstruction and frequent exacerbation
What are the three major corticosteroids used to treat COPD?
What is the MOA of PDE-4 inhibitors in treating asthma?
increase cAMP to induce Smooth muscle relaxation and decreased inflammation
What are the two PDE-4 inhibitors used to treat COPD?
When are inhaled corticosteroids used in COPD?
For repeated exacerbations
What is the benefit of mucoactive agents in COPD treatment?
No effect on airflow or sputum volume, and can actually induce bronchoconstriction
What is the only therapy that improves survival with COPD?
What are the benefits of pulmonary rehab? (4)
-Improves exercise capacity
-Decreases healthcare utilization
What are the severe ssx of COPD exacerbation? (5)
-Mental status change
-Only single words spoken
What are the 5 major ancillary tests for COPD exacerbation?
What happens to the bicarb with COPD?
What are the three steps of outpatient management of COPD exacerbation?
-Increase short acting bronchodilators
-abx if infx
What are the indications for inpatient management of COPD?
-Dyspnea at rest
-failed outpatient management
-accessory muscle use
What causes the orthopnea with COPD?
Increased pressure from the diaphragm
Why is it important to assess for edema with COPD exacerbation?
r/o right heart failure
What is the oxygen saturation goal with COPD pts? Why?
-any higher will encourage V/Q mismatch d/t dead space ("stealing blood from the good parts") and actually increase CO2 levels
What are the three cardinal ssx that warrant abx treatment with COPD?
-Increased sputum volume/purulence
-if mechanical ventilation is required
What is the treatment for an acute COPD exacerbation?
Short acting beta-2 agonists wwo anticholinergics
What are the CT findings of COPD, besides the barrel chest?
Can find bullae
What are the two goals of trying to reduce the symptoms of COPD?
Improve exercise status
What are the three goals of reducing risk for COPD patients?
-Prevent disease progression
-Prevent and treat exacerbations
Why are steroids not first line therapy for COPD?
Not dealing with inflammation like asthma
What should be done with patients with MIld, moderate, and severe COPD?
Mild =Short term bronchodilator
Moderate = +Long acting bronchodilator
Severe= +inhaled glucocorticoid
When is long term oxygen therapy needed for COPD?
Very severe: FEV1 less than 30% predicted, or chronic respiratory failure
What is the use of systemic corticosteroids in treating COPD?
There is none--increases morbidity and mortality
What is the level of pO2 on RA that indicates the need for supplemental oxygen?
Less than 55 mmHg
What is the level of pO2 on RA with cor pulmonale that indicates the need for supplemental oxygen?
A decrease in SpO2 to less than what percent is an indication for supplemental oxygen?
Less than 88%
What is the ABG presentation order? (5)
When is lung volume surgical resection indicated for COPD?
Upper lobe emphysema with low base-line exercise capacity