COPD Flashcards by Stefan Khensouri

define COPD

common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases

How well did you know this?

Not at all

Perfectly

what are the most common respiratory symptoms of COPD?

dyspnea, cough, and/or sputum production

How well did you know this?

Not at all

Perfectly

main risk factor for COPD?

tobacco smoking

biomass fuel exposure and air pollution may contribute

How well did you know this?

Not at all

Perfectly

what host factors predispose individuals to develop COPD?

genetic abnormalities
abnormal lung development
accelerated aging

How well did you know this?

Not at all

Perfectly

what is required to make the diagnosis of COPD?

spirometry

How well did you know this?

Not at all

Perfectly

what are the goals of COPD assessment?

determine the level of airflow limitation
impact of disease on the pt’s health status
risk of future events (exacerbations, hospitalizations, or death)

How well did you know this?

Not at all

Perfectly

what are concomitant chronic diseases that occur frequently in COPD pts?

cardiovascular disease
skeletal muscle dysfunction
metabolic syndrome
osteoporosis 
depression
anxiety
lung cancer

How well did you know this?

Not at all

Perfectly

what are other symptoms of COPD?

wheezing/chest tightness
fatigue
weight loss
anorexia
syncope
rib fractures
ankle swelling
depression
anxiety

How well did you know this?

Not at all

Perfectly

classify GOLD 1-4 for the severity of airflow limitation

GOLD 1 - mild, FEV1 80% or more
GOLD 2 - moderate, FEV1 50-79%
GOLD 3 - severe, FEV1 30-49%
GOLD 4 - very severe, FEV1 <30%

How well did you know this?

Not at all

Perfectly

what are examples of diagnostic tools for COPD?

COPD assessment test (CAT)

chronic respiratory questionnaire (CRQ)

How well did you know this?

Not at all

Perfectly

how to treat mild COPD?

SABAs

How well did you know this?

Not at all

Perfectly

how to treat moderate COPD?

SABAs plus antibiotics and/or oral corticosteroids

How well did you know this?

Not at all

Perfectly

how to treat severe COPD?

hospitalization or visits ER

How well did you know this?

Not at all

Perfectly

what may also predict exacerbation rates in pts treated with LABA without ICS?

blood eosinophil count

How well did you know this?

Not at all

Perfectly

ABCD assessment stool takes into account what?

exacerbation history

symptom score based on either CAT or mMRC

How well did you know this?

Not at all

Perfectly

define mMRC scores from 0-4

0 - none, only breathlessness with strenuous exercise
1 - mild, SOB hurrying or walking up a hill
2 - moderate, walks slower than age group or has to stop for breath when walking on level ground at own pace
3 - severe, stops for breaths after walking 100 meters or a few minutes on level ground
4 - very severe, breathless when dressing/undressing or too breathless to leave the house

How well did you know this?

Not at all

Perfectly

what does A mean on COPD severity assessment?

less symptoms low risk, FEV 1 50% or greater, 0-1 exacerbations in last year
<10 CAT score OR 0-1 mMRC

How well did you know this?

Not at all

Perfectly

what does B mean on COPD severity assessment?

more symptoms
FEV1 50% or greater
0-1 exacerbations in last year
10 or greater CAT score
2 or greater mMRC socre

How well did you know this?

Not at all

Perfectly

what does C mean on COPD severity assessment?

less symptoms, high risk
FEV1 less than 50%
2 or more exacerbations OR 1 or more exacerbations leading to hospital admission in past year
CAT score <10
mMRC score 0-1

How well did you know this?

Not at all

Perfectly

what does D mean on COPD severity assessment?

more symptoms, high risk
FEV1 <50%
2 or more exacerbations or 1 or more leading to hospital admission
10 or greater CAT score
2 or more mMRC score

How well did you know this?

Not at all

Perfectly

what genetic deficiency is associated with COPD?

alpha-1 antitrypsin deficiency (AATD) in emphysema particularly less than 45 y/o

How well did you know this?

Not at all

Perfectly

what is the key preventative measure against COPD?

smoking cessation

How well did you know this?

Not at all

Perfectly

which vaccinations decrease lower respiratory tract infections?

flu vaccination

pneumococcal vaccination

How well did you know this?

Not at all

Perfectly

in pts with severe resting chronic hypoxemia, what improves survival?

long-term O2

How well did you know this?

Not at all

Perfectly

in pts with severe chronic hypercapnia and a hx of hospitalization for acute respiratory failure, what may decrease mortality and prevent re-hospitalization?

long-term non-invasive ventilation

pts with advanced emphysema refractory to optimized medical care should try what treatments?

surgical or bronchoscopic interventional treatments

between LABA and LAMA, which has a greater effect on exacerbation reduction?

LAMAs

regular treatment with ICS increases the risk of ____

pneumonia

in pts with chronic bronchitis, severe to very severe COPD and a hx of exacerbations, what may improve lung function and reduce moderate and severe exacerbations?

PDE4 inhibitor

what antibiotics help reduce exacerbations over one year?

azithromycin and erythromycin

what does pulmonary rehab improve?

dyspnea health status exercise tolerance in stable pts

which pts should receive long-term O2?

pts with severe chronic resting arterial hypoxemia

which pts is lung volume reduction surgery indicated for?

severe emphysema pts with an upper-lobe emphysema and low post-rehab exercise capacity

what are the main treatment goals of COPD?

reduction of symptoms and future risk of exacerbations

what types of counseling are recommended in treating tobacco use/dependence?

practical counseling social support of family and friends social support outside of treatment

what are first-line pharmacotherapies for tobacco dependence?

``` varenicline bupropion sustained release nicotine gum nictonine inhaler nicotine nasal spray nicotine patch ```

when are SABAs recommended over LABAs and LAMAs?

only if pt has occasional dyspnea

group A COPD, what treatment?

bronchodilator (can be short-acting or long-acting

group B COPD, what treatment?

LABA or LAMA and if persistent symptoms, do LAMA + LABA

group C COPD, what treatment?

LAMA | if further exacerbation, do LAMA + LABA

group D COPD, what treatment?

LAMA + LABA | if further exacerbation, do LAMA + LABA + ICS

if pts treated with LABA + LAMA + ICS still have exacerbations, what are you options?

roflumilast (FEV1 < 50% and at least one hospitalization for an exacerbation in the previous year) macrolide (azithromycin) stopping ICS

what are non-pharmacological treatments of COPD?

``` education/self-management physical activity pulmonary rehab program exercise training self-management education end of live and palliative care nutritional support vaccination oxygen therapy ```

long-term O2 therapy indicated for stable pts who have?

PaO2 at or below 7.3 kPA (55 mmHg) or SaO2 at or below 88% with or without hypercapnia confirmed twice over a three week period

when do you follow-up on supplemental oxygen?

recheck in 60-90 days to see if oxygen is still indicated or effective

what pts is interventional bronchoscopy and surgery indicated for?

emphysema large bulla, surgical bullectomy very severe COPD - lung transplant consider

what do you monitor and follow-up on each visit?

``` measurements (spirometry) symptoms (cough, sputum, breathlessness, fatigue, sleep disturbance) exacerbations imaging smoking status pharmacotherapy ```

what is the most common cause of exacerbations of COPD?

upper respiratory tract infections

what are the initial bronchodilators in treating acute exacerbations?

SABAs with or w/o anticholinergics

what should be initiated as soon as possible before hospital discharge?

LABAs

what is the duration of therapy for systemic corticosteroids?

5-7 days

what is the duration of therapy for antibiotics?

5-7 days

what is the first mode of ventilation recommended in COPD pts with acute respiratory failure who have no absolute contraindication?

non-invasive mechanical ventilation

define respiratory failure

``` RR 20-30 bpm; no accessory respiratory muscles no change in mental status hypoxemia with supplemental O2 28-35% FiO2 no increase in PaCO2 ```

define acute respiratory failure - non-life-threatening

``` RR > 30 bpm use accessory muscles no change in mental status hypoxemia with 25-30% FiO2 PaCO2 increased 50-60 mmHg ```

define acute respiratory failure - life-threatening

``` RR > 30 bpm use accessory muscles acute changes in mental status hypoxemia FiO2 > 40% PaCO2 increased > 60 mmHg acidosis pH 7.25 or less ```

how to manage severe but not life-threatening exacerbations?

``` administer supplemental O2 bronchodilators consider oral corticosteroids consider antibiotics consider noninvasive mechanical ventilation monitor fluid balance consider SC heparin ```

what are the three main classes of medications for COPD exacerbations?

bronchodilators corticosteroids antibiotics

what are indications for noninvasive mechanical ventilation?

``` respiratory acidosis pH 7.35 or less or PaCO2 6 or greater (45 mmHg) severe dyspnea (respiratory accessory muscles) persistent hypoxemia despite supplemental O2 ```

what are indications for invasive mechanical ventilation?

``` unable to tolerate NIV s/p respiratory/cardiac arrest diminished consciousness or psychomotor agitation massive aspiration severe hemodynamic instability severe arrhythmias ```

when should you follow up with COPD with exacerbation pt?

<4 weeks = early | <12 weeks = late

the main cause of death in pts with COPD?

lung cancer

in general, the presence of comorbidities should or should not altered COPD treatment?

should not alter

what are frequent/important comorbidities of COPD?

osteoporosis | depression/anxiety

what bronchodilator improves the effectiveness of pulmonary rehab?

tiotropium

what FEV1 are PDE4 inhibitors indicated?

FEV1 < 50%

what class of medication would you give to someone with high eosinophils?

corticosteroids

what are ADR for beta agonists?

increase heart rate decrease potassium tremor