COPD Flashcards
(35 cards)
COPD definition
- persistent respiratory sx and airflow limitations
- due to airway and/or alveolar abnormalities
- dev fibrosis, alveolar wall destruction, and mucus hypersecretion
COPD symptoms
- persistent and progressive dyspnea
- chronic cough
- chronic sputum production
- hx of risk factor exposure
- family hx
- hyperinflation
risk factors for COPD
- smoking
- smoke from cooking/ heating fuels
- occupational
COPD phenotypes
- chronic bronchitis
- emphysema
- asthma- COPD overlap
- alpha-1 anti-tripsin deficiency (AATD)- hereditary cause
chronic bronchitis
- chronic cough for 3 mo in each of 2 successive years
emphysema
- abnormal permanent enlargement of airspaces distal to terminal bronchioles
markers for hyperinflation
- inspiratory capacity
- functional residual capacity
how do you grade severity of COPD
- GOLD severity rating
- must have FEV1/ FVC ratio < 70%
- compare FEV1 ratio to predicted value
- graded 1-4
GOLD 1
- mild
- FEV1 > 80% predicted
GOLD 2
- moderate
- FEV1 50-80% predicted
GOLD 3
- severe
- FEV1 30-50% predicted
GOLD 4
- very severe
- FEV1 < 30%
COPD exacerbation
- acute worsening of respiratory sx
- requires additional therapy
mild COPD exacerbation tx
- short acting bronchodilator
moderate COPD exacerbation
- short acting bronchodilator PLUS abx/steroids
severe COPD exacerbations
- hospitalization or ED
- possible respiratory failure
treatments for exacerbations
- bronchodilators
- O2 if hypoxic
- PO or IV steroids- shorten recovery time and improve lung function
- abx- often get superimposed infections
group A exacerbation risk/ sx burden
- 0 hospitalizations
- 0-1 exacerbations
- mMRC 0-1 or CAT < 10
- tx- bronchodilators
group B exacerbation risk/ sx burden
- 0 hospitalizations
- 0-1 exacerbations
- mMRC 2+ or CAT 10+
- tx- LAMA or LABA
group C exacerbation risk/ sx burden
- 1+ hospitalizations
- 2+ exacerbations
- mMRC 0-1 or CAT < 10
- tx- LAMA
group D exacerbation risk/ sx burden
- 1+ hospitalizations
- 2+ exacerbations
- mMRC 2+ or CAT 10+
goals of treatment
- relieve sx
- improve exs tolerance
- improve health status
- prevent progression
- prevent exacerbations
- reduce mortality
- generally: reduce sx and risk
COPD management cycle
- review- sx, exacerbation frequency
- assess- inhaler technique, adherence, non-pharm approaches
- adjust- escalate, switch devices, de-escalate
general tx considerations for COPD
- inhaled preferred
- combo tx is better than ICS or LAMA alone
- SAMA/ SABA for acute exacerbations only
- maintenance with long acting bronchodilators preferred