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Clin Med II- Exam 2 > COPD > Flashcards

COPD Flashcards

1
Q

highest COPD prevalence

A

65-74 YO

morbidity greater in males

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2
Q

Pathphys behind COPD

A

inflammation –> small airway disease (inflammation/remodeling) & parenchymal destruction (loss of alveolar attachments/decrease in elastic recoil) –> airflow limitation

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3
Q

chronic bronchitis

A

mucous blocks airways;

inflammation and swelling further narrows airway

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4
Q

Emphysema

A

damage to alveoli prevent air exchange;

air becomes trapped

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5
Q

Blue bloater

A

Chronic bronchitis

cyanosis and overweight
hypoxemia and respiratory acidosis more common; cor pulmonale from pulm HTN (trouble getting air in AND out)

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6
Q

Pink puffer

A

emphysema

pursed-lip breathing
skin color and thin body
accessory mm. use (makes them thin)

gets air in but can’t get it out

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7
Q

COPD subtypes

A

chronic bronchitis
emphysema
chronic obstructive asthma

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8
Q

What is considered chronic bronchitis?

A

chronic PRODUCTIVE cough for 3+ months during 2 consecutive yrs w/ no other cause

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9
Q

Structural change for chronic bronchitis

A

mucous gland enlargement –> hyper secretion
bronchial squamous metaplasia
loss of ciliary transport

inflammation of bronchial wall and infiltration of sub-mucosal layer by NEUTROPHILS

obstruction is INSPIRATORY and EXPIRATORY

hypoxemia & hypercapnia

less parenchymal damage than emphysema

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10
Q

Emphysema changes

A

entrapment of air in spaces distal to terminal bronchioles due to destruction of alveolar walls
decreased elastic recoil
loss of alveolar supporting structure = airway narrowing

not clearly understood:

  • may be too much elastase
  • may be too little antitrypsin activity

obstruction is EXPIRATORY
not associated w/ significant hypoexmia until later in disease (destruction of capilarry bed, resulting in reduced DLCO)

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11
Q

neutrophil elastase

A

protease enzyme secreted by . neutrophils and macrophages during inflammations; destroys bacteria and host tissue

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12
Q

alpha-1 antitrypsin

A

inhibitor of neutrophil elastase; deficiency leads to breakdown of lung structure by elastase

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13
Q

Asthma

A

chronic inflammatory disorder of airways - EOSINOPHIL MEDIATED

airway hyper-reactivity –> increased secretions, mucosal edema, constriction of bronchial smooth mm. –> airway obstruction

REVERSIBLE

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14
Q

Risk factors for COPD

A 
SMOKING!
enviornmental/occupation
second hand smoke
hyper-responsiveness (asthma)
genetic RF: alpha-1-antitrypsin deficiency (premature emphysema)
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15
Q

Cig smoking

A

stimulates elastase

causes cytotoxic oxygen radicals from WBC’s in lung tissue

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16
Q

How to dx alpha-1-antitrypsin deficiency

A

emphysema <45 YO

process accelerated in smokers w/ AAT deficiency

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17
Q

Clinical presentation of COPD

A

dyspnea (DOE earliest sx), chronic cough, sputum production

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18
Q

PE findings for COPD

A 
tripod positioning
cyanosis
tobacco staining of fingers
JVD, use of accessory mm.
pursed lip breathing
Lung: barrel chest, prolonged expiration, increased resonance on percussion, decreased breath sounds, wheezing, crackles at bases
Heart: S3 gallop, RV lift
ABD: hepatomegaly
Ext: muscle wasting, peripheral edema
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19
Q

pursed lip breathing

A

ordinary breathing allows early bronchial collapse on exhalation; pursed lip breathing achieves resistance to outflow, raising intrabronchial pressure, keep bronchi open; thus more air can be expelled

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20
Q

Heart in COPD

A

S3, RV lift

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21
Q

Cor pulmonale

A

altered strucutre (hypertrophy or dilation) and/or imparied funciton of RV that results from pulmonary HTN associated w/ COPD

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22
Q

Labs/dx for COPD

A 
spirometry
CBC, BNP, cardiac enzymes, metabolic panel, AAT
pulse ox
ABG
EKG
Sputum exam
CXR/HRCT
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23
Q

FVC (forced vital capacity)

A

amt of air forcefully exhaled during max forced expiration (N: 80-120%)

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24
Q

FEV1 (forced expiratory volume in 1 sec)

A

normal: 80-120%

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25
FEV1/FVC ratio
% of FVC expired in 1 sec (N: 70-80%; or greater that LLN 5th percentile)
26
Dx of COPD
1. pre and post bronchodilator (FEV1/FVC <0.7 is obstructive pattern) 2. review post-bronchodilator FEV1% predicted - determine GOLD grade
27
PFT in COPD
FEV1/FVC < 0.7 decreased FEV1 increased TLC (vital capacity + RV) Decreased DLCO (if severe emphysema)
28
CBC in COPD
usually normal - r/o anemia chronic bronchitis - polycythemia due to chronic hypoxia leukocytosis may be present during acute exacerbations of COPD
29
Pulse Ox
if <92%,, assess further w/ ABG
30
ABG
usually mild-mod hypoxemia w/o hypercapnia as disease progresses hypoxemia worsens and CO2 increases (respiratory acidosis)
31
When to obtain sputum culture
in-patient and unresponsive to initial abx tx
32
EKG findings in COPD
tachy R atrial enlargement R axis deviation and/or RVH
33
CXR findings
exclude other ddx signs of air trapping (increased AP diameter, hyperinflaation, hyperlucency, flat diaphragms) blebs or bullae (pathognomonic for emphysema) perivascular or peribronchial markings in chronic bronchitis
34
Pathognomonic for emphysema
blebs or bullae
35
CXR findings for emphysema
hyperinflation (possibly w/ bullae) flattening of diaphragms enlargement of retrosternal air space
36
CXR findings suggestive of chronic bronchitis
cardiac enlargement pulm. congestion increased lung markings
37
chest CT
helpful, but not needed for dx obtain if sxs suggest complication of COPD (pneumonia, pneumothorax, large bullae), alt. dx (PE) or if considering lung volume reduction surgery (HRCT)
38
Tx for group A
1. SABA ORRRR | 2. SABA + SAMA combo used PRN
39
Tx for group B
long-acting bronchodilator (LABA or LAMA)
40
Tx for group C
LAMA
41
Tx for group D
LABA + LAMA, or consider ICS + LABA
42
Effects of bronchodilators
bronchodilation improved mucociliary clearance diaphragmatic action cardiact contractility
43
SABA drugs
albuterol - 2 puffs q 4-6 hrs
44
LABA drugs
salmeterol, formoterol q12 h dosing
45
B2 agonists
bronchilation; no effect on sputum/secretions
46
SE of B2 agonists
palpitations, tachy, insomnia, tremors
47
SAMA drugs
``` ipratropium bromide (atrovent) Ipratropium plus albuterol (combivent) ``` 2 puffs BID-QID
48
LAMA drugs
``` tiotripium bromide (spiriva) - q daily Umeclidinium (incruse ellipta) - q daily ```
49
anticholinergics
good bronchodilation; reduces air trapping in lungs less cardiac stim. effect
50
SE of anticholinergics
dry mouth, metallic taste, HA, cough
51
Combo meds for COPD
LAMA + LABA ``` bevespi aerosphere (BID) utibron neohaler (BID) Stiolto respimat (QD) Anoro Ellipta (QD) ```
52
Theophylline (methylxanthine)
used for refractory cases toxicity is common tachy, arrhythmias, seizures, HA, nasea drug-drug interxns
53
Corticosteroids
alone or in combo w/ LABA Advair, dulera, symbicort, breo ellipta
54
what do ICS do
reduce mucosal edema/inflammation by inhibiting prostaglandins --> dec secretions increase responsiveness to beta-adrenergics
55
SE of ICS
oral candidiasis, bruising
56
Tx for AAT
Antiprotease (weekly-monthly injections) costly and controversial
57
Lab values for AAT
<11 uM
58
Adjunct therapy for COPD
pulm. rehab (Stages B-D) Oxygen (goal >90%) lung volume reduction surgery?
59
Supplemental oxygen
prolongs survival | min. 12 hrs/day
60
indication for supplemental oxygen
chronic dyspnea at rest | PaO2 <55 or SaO2 <88%
61
Caution for supplemental O2
may reduce drive to breath and cause resp acidosis (maintain O2 sat 90-92%
62
Minimizing complications
flu vaccine pneumo vaccine (PPV13, PCV23) exercise early recognition of infection
63
Acute exacerbation
increased dyspnea increase in cough frequency/severity sputum increases or becomes purulent * contribute to high mortality
64
Trigger of acute exacerbations
``` respiratory illness (70%) pollution ``` viral most common: may lead to secondary bacterial pneumo (H. influenzae, S. pneumo M. catarrhalis, mycoplasma pneumo, pseudomonas)
65
outpatient management of acute exacerbation
increase dose of shortacting bronchodilator; add ipratropium if not taking it oral steroids: 40mg/day x 5 days (reduces recovery time and hospital time) abx (mod-severe) hospitilization if severe
66
Abx for uncomplicated COPD acute exacerbation
Macrolide*** | or cephalosporin, doxy, bactrim
67
Abx for complicated COPD acute exacerbation
fluoroquinolone (moxifloxacin, gemifloxacin, levofloxacin) *** (or augmentin)
68
Indications for hospitilizations
``` severe s/sx severe COPD (FEV1<50) comorbidities new signs (cyanosis, edema, new arrhythmia) failure to respond to meds older insufficient home support ```

Clin Med II- Exam 2 (7 decks)

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