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clinical medicine II exam 2 > COPD > Flashcards

COPD Flashcards

(54 cards)

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1
Q

Describe process that leads to COPD

A

inflammation -> small airway disease (airway remodeling) and parenchymal destruction (loss of alveolar attachments; decrease of elastic recoil ) -> airflow limitation

  • think paper bag
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2
Q

what are the clinical subtypes of COPD

A
  1. chronic bronchitis
  2. emphysema
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3
Q

differentiate between chronic bronchitis and emphysema patients in terms of appearance

A
  • chronic bronchitis: blue bloaters
    • cyanosis; overweight
    • hypoxemia; respiratory acidosis, cor pulmonale more common
  • emphysema: pink puffers
    • pursed lip breathing
    • thin body habitus
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4
Q

define chronic bronchitis

A
  • chronic productive cough x 3 months, during 2 consecutive years with no other cause
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5
Q

structural changes associated with chronic bronchitis

A
  • mucous gland enlargement -> hypersecretion
  • bronchial squamous metaplasia
  • loss of ciliary transport
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6
Q

chronic bronchitis: inflammation of bronchial wall and infiltration of sub mucosal layer by what types of cells

A

neutrophils

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7
Q

in chronic bronchitis, the obstruction is inspiratory or expiratory?

A

inspiratory and expiratory -> leads to hypoxemia and hypercapnia

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8
Q

which subtype of COPD has more parenchymal damage

A

emphysema : more alveolar sac damage

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9
Q

define emphysema

A
  • pathologic enlargement of the air spaces distal to the terminal bornchioles due to desctruction of the alveolar walls
    • ​reduced alveolar surface area
    • decreased elastic recoil
    • loss of alveolar supporting structures -> airway narrowing
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10
Q

destructive process in emphysema is due to

A
  • too much elastase
    • breaks down elastin and destroys elasticity of lung
  • too little antitrypsin
    • inhibits elastase
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11
Q

in emphysema, airflow obstruction occurs mostly during inspiration or expiration?

A

exhalation

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12
Q

which COPD subytpe is associated with hypoxemia

A
  • chronic bronchitis
    • emphysema: not associated with significant hypoxemia until later in disease severity
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13
Q

asthma is a chronic inflammatory disorder of the airways that is primarily mediated by what cell type

A

eosinophil

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14
Q

define asthma and explain why is it different from COPD

A
  • airway hyper-reactivity -> increased secretions, mucosal edema -> constriction of bronchial smooth muscle -> aiway obstruction
  • reversible
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15
Q

name the risk factors for COPD

A
  • cigarette smoking
  • air pollution
  • genetic: alpha-1 antitrypsin deficiency
    • premature emphysema
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16
Q

how does cigarette smoking increase risk for COPD

A

stimulates elastase activity, causing degenerative changes in elastin and alveolar structures

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17
Q

alpha 1 antitrypin deficiency causes an early onset of

A

emphysema

  • <1% of US cases
  • develops in smokers at age 40 yo; nonsmokers 53 yo
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18
Q

what are the cardinal symptoms of COPD

A
  • dyspnea
  • chronic cough
  • sputum production
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19
Q

when does COPD typically present (what age)

A

50-60s

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20
Q

clinical presentation

  • accessory muscle use
  • increased AP diameter
  • pursed lip breathing
A

emphysema

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21
Q

function of pursed lip breathing

A
  • ordinary breathing in COPD allows early bronchial collapse on exhalation
  • pursed lip breathing achieves resistance to outflow at the lips -> raises intrabronchial pressure -> bronchi stay open -> more air expelled
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22
Q

what do you expect to hear on percussion of COPD patients

Study These Flashcards
A

hyper-resonant: due to air trapping

23
Q

what test is used to establish the diagnosis and determine the stage of COPD

24
Q

what do you expect to see in the spirometry results for COPD patents

Study These Flashcards
A
  • FEV1/FVC < 0.7 -> obstruction
  • decreased FEV1
  • increased TLC
  • FEV1 predicted that is not reversible
25
Why could CBC show polycythemia in COPD patients
* polycythemia: abnormally increased concentration of hemoglobin in the blood * increase in RBC due to hypoxemia of chronic bronchitis
26
when should you get an arterial blood gas
pulse oximetery shows O2 **\< 92%**
27
what imaging is used for routine workup of COPD
* CXR * high resolution CT: greater sensitivity and specificity than CXR for the diagnosis of COPD but is not necessary for routine workup
28
These CXR findings are consistent with * hyperinflation (possibly with bullae) * flattening of diaphragms * enlargement of retrosternal air space
emphysema
29
These CXR findings are consistent with * cardiac enlargment * pulmonary congestion * increased lung markings
chronic bronchitis
30
list the GOLD strategy for staging of COPD
1. **determine if obstructive pattern** * FEV1/FVC \<0.7 2. **determine severity** * FEV1 % 3. **assess symptoms** * patient rating scale: mMRC 4. **determine exacerbation risk** (in past yr) * 0-1 exacerbations * \> 2 exacerbations OR 1 or more hospitalizations
31
goals of disease managment of COPD
* prevent progression * **smoking cessation** * relieve symptoms * improve exercise tolerance * reduce mortality
32
what is the mainstay of therapy for COPD
* bronchodilators: **inhaled B2-agonists** and **anticholinergics**
33
SABA: protype drug and dosing
* albuterol (B2 agonist * 2 puffs q 4-6 hrs
34
side effect of B2 agonists
* palpitations * tachycardia * insomnia * tremors
35
name two LABA (long acting beta 2 agonists)
* **Salmeterol** * **Formoterol** * both given q12 hr
36
Name two short acting anticholinergics used for COPD and dosage
* Ipratropium bromide (atrovent) * Ipratropium plus albuterol (Combivent) * 2 puffs BID-QID
37
Name one long acting cholinergics used for COPD and dosage
* Tiotropium bromide (spiriva) * once a day
38
side effects of anticholinergics
* dry mouth * metallic taste
39
function of corticosteroids in the treatment of COPD
* reduces mucosal edema/inflammation by inhibiting prostaglandins * increases responsiveness to beta-adrenergics * SE: oral candidiasis, bruising
40
what is Roflumilast? Function?
* PDE-4 inhibitor * for refractory cases as adjunct to bronchodilator * anti-inflammatory effect
41
side effects of Roflumilast
* Nausea * Diarrhea * abd pain * weight loss * HA
42
what is the first line treatment for COPD: Stage A
short acting bronchodilator * doesnt matter if beta 2 agonist or anticholinergic * used as rescue inhaler
43
what is the first line treatment for COPD: Stage B
long acting bronchodilator
44
what is the first line treatment for COPD: Stage C
* **inhaled corticosteroid** + * LABA or long-acting anticholinergic
45
what is the first line treatment for COPD: Stage D
* inhaled corticosteroid + * LABA _and/or_ long acting anticholinergic
46
tx for patients with alpha1-antitrypsin deficiency
* antiprotease therapy * weekly or monthly injections
47
some patients with COPD wear supplemental oxygen a minimum of 12 hours a day. When is it indicated? Purpose?
* indicated if chronic dyspnea at rest * **PaO2 \< 55 mmHg or SaO2 \< 88%** * prolongs survival
48
what is the concern for patients with COPD to wear supplemental oxygen
concern that high flow O2 may reduce drive to breath and cause respiratory acidosis (_maintain O2 sat 90-92%_)
49
what two things should patients with COPD get to minimize complications and exacerbations
* annual influenza vaccine * pneumococcal vaccine (PPV23)
50
signs of an acute COPD exacerbation
* cough increases in frequency or severity * sputum production changes * dyspnea increases
51
most common triggers for acute COPD exacerbation
* viral infection: **rhinovirus and influenza**
52
outpatient treatment/management for acute COPD exacerbation
* SABA * oral steroids * antibiotics?
53
when should abx be given in outpatient treatment/management for acute COPD exacerbation
* if **2/3** cardinal symptoms are present * increased dyspnea * increased sputum production * increased sputum purulence
54
What makes a COPD patient at a higher mortality risk
* BODE index * cigarette smoking * BMI \< 21 * male * FEV1 * mMRC score * exercise capacity

clinical medicine II exam 2 (7 decks)

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