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Flashcards in COPD Deck (64):
1

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

2

What is the difference between COPD and asthma?

Asthma is reversible

3

What percent of the US population has COPD?

6.3%

4

What is the typical COPD pt?

65+ poor white woman that smokes

5

What are the risk factors for COPD?

Cigarette smoking
Occupational exposures
Air pollution

6

What are the three characteristics of the small airway disease underlying COPD?

Airway inflammation
Airway fibrosis
Increased resistance

7

Parenchymal destruction in COPD results in what two major effects?

-Loss of alveolar attachments
-Decrease of elastic recoil

8

What is the definition of chronic bronchitis?

Productive cough that occurs everyday for at least 3 months, two years in a row

9

What are the three COPD subsets?

Chronic bronchitis
Emphysema
Asthma

10

What are the ssx of COPD? How fast is the onset?

-Productive cough
-DOE
-progressive symptoms

11

What are the physical findings late in the course of COPD? (3)

-Using accessory muscles at rest
-Increased AP diameter
-Heart failure

12

What happens with FEV1 and FEV1/FVC with COPD patients?

Decreased FEV1, and lower FEV1/FVC (less than 0.7)

13

What are the four steps of assessing COPD?

1. Assess symptoms
2. Assess severity by spirometry
3. Exacerbations
4. Comorbidities

14

Is the cough associated with COPD usually productive?

No, but may be variable from day-to-day

15

What are the characteristics of dyspnea with COPD?

Progressive, worse with exercise

16

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%

17

What happens to the flow-volume loop with obstructive lung disease?

Indentation of the curve

18

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%

19

True or false: any hospitalization for COPD exacerbations should be considered a high risk pt

True

20

What are the comorbidities with COPD?

-CV disease
-Osteoporosis
-Respiratory infections
-DM
-Lung CA
-Bronchiectasis

21

What is bronchiectasis?

Chronic inflammation of the airway leading to fibrotic changes, and impaired mucus clearance

22

What are the two main goals of therapy for COPD?

Relieve ssx
Reduce risk

23

What is the single most important intervention for COPD?

Smoking cessation

24

How much faster do your lungs age with smoking?

x2

25

True or false: there is still benefit of smoking cessation at age 65

True

26

What medications have been should to modify long term decline of lung function with COPD?

None

27

What are the goals of pharmacotherapy with COPD?

Decrease ssx and complications

28

What are the beta agonists used to treat COPD?

-albuterol
-Salbutamol
-Levalbuterol
-Metaproterenol

29

What is the major anticholinergic used to treat COPD?

Ipratropium

30

What is the MOA of theophylline?

PDE inhibitors to Increase cAMP to induce bronchodilation

31

What are the major issues of theophylline use?

Narrow therapeutic index

32

What are the 5 long acting bronchodilators?

-salmeterol
-Formoterol
-Arformoterol
-Indacaterol
-Vilanterol

33

What are the four major muscarinic long acting bronchodilators?

-Tiotropium
-Aclidinium
-Umeclidinium
-Glycopyrronium

34

When are corticosteroids used for COPD?

Used in combination of LABA or LAMA for severe obstruction and frequent exacerbation

35

What are the three major corticosteroids used to treat COPD?

Fluticasone
Budesonide
Mometasone

36

What is the MOA of PDE-4 inhibitors in treating asthma?

increase cAMP to induce Smooth muscle relaxation and decreased inflammation

37

What are the two PDE-4 inhibitors used to treat COPD?

Cilomilast
Roflumilast

38

When are inhaled corticosteroids used in COPD?

For repeated exacerbations

39

What is the benefit of mucoactive agents in COPD treatment?

No effect on airflow or sputum volume, and can actually induce bronchoconstriction

40

What is the only therapy that improves survival with COPD?

Oxygen

41

What are the benefits of pulmonary rehab? (4)

-Improves exercise capacity
-Decreases dyspnea
-Improve QOL
-Decreases healthcare utilization

42

What are the severe ssx of COPD exacerbation? (5)

-Mental status change
-Only single words spoken
-Silent chest
-Hemodynamic instability
-Paradoxical breathing

43

What are the 5 major ancillary tests for COPD exacerbation?

-ABG
-CXR
-Oximetry
-EKG
-CBC, lytes

44

What happens to the bicarb with COPD?

Increases

45

What are the three steps of outpatient management of COPD exacerbation?

-Systemic steroids
-Increase short acting bronchodilators
-abx if infx

46

What are the indications for inpatient management of COPD?

-Dyspnea at rest
-failed outpatient management
-hypoxemic
-accessory muscle use

47

What causes the orthopnea with COPD?

Increased pressure from the diaphragm

48

Why is it important to assess for edema with COPD exacerbation?

r/o right heart failure

49

What is the oxygen saturation goal with COPD pts? Why?

-88-92%
-any higher will encourage V/Q mismatch d/t dead space ("stealing blood from the good parts") and actually increase CO2 levels

50

What are the three cardinal ssx that warrant abx treatment with COPD?

-Increased dyspnea
-Increased sputum volume/purulence
-if mechanical ventilation is required

51

What is the treatment for an acute COPD exacerbation?

Short acting beta-2 agonists wwo anticholinergics

52

What are the CT findings of COPD, besides the barrel chest?

Can find bullae

53

What are the two goals of trying to reduce the symptoms of COPD?

Improve exercise status
Improve health

54

What are the three goals of reducing risk for COPD patients?

-Prevent disease progression
-Prevent and treat exacerbations
-Reduce mortality

55

Why are steroids not first line therapy for COPD?

Not dealing with inflammation like asthma

56

What should be done with patients with MIld, moderate, and severe COPD?

Mild =Short term bronchodilator
Moderate = +Long acting bronchodilator
Severe= +inhaled glucocorticoid

57

When is long term oxygen therapy needed for COPD?

Very severe: FEV1 less than 30% predicted, or chronic respiratory failure

58

What is the use of systemic corticosteroids in treating COPD?

There is none--increases morbidity and mortality

59

What is the level of pO2 on RA that indicates the need for supplemental oxygen?

Less than 55 mmHg

60

What is the level of pO2 on RA with cor pulmonale that indicates the need for supplemental oxygen?

56-59 mmHg

61

A decrease in SpO2 to less than what percent is an indication for supplemental oxygen?

Less than 88%

62

What is the ABG presentation order? (5)

pH/pCO2/pO2/HCO3/sat

63

When is lung volume surgical resection indicated for COPD?

Upper lobe emphysema with low base-line exercise capacity

64

What is the trade off of endobronchial valve treatment?

Improved lung function and exercise tolerance for most exacerbations and pneumonia