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Flashcards in COPD -Goya Deck (29):
1

What is COPD? What is the major risk factor?

cCOPD is defined as a disease characterized by airflow obstruction that is not fully reversible.

Airflow limitation is usually progressive & associated with an abnormal inflammatory response of the lungs to noxious particles or gases.

risk factor=smoking (15% of smokers develop COPD)

2

What is chronic bronchitis?

chronic productive cough for 3 months in each of the 2 successive years in a pt in whom other causes of chronic cough have been excluded

3

What is emphysema?

abnormal permanent enlargement of the air spaces distal to the terminal bronchioles accompanied by destruction of their walls and without obvious fibrosis

4

What genetic abnormality leads to COPD?

alpha-1-antitrypsin deficiency (AAT)

AAT is made in the liver and found in the lungs and is important in the inhibition of the neutrophil protease

5

How does the rate of decline of FEV1 in a nonsmoker compare to that of a smoker? A smoker who quit?

smokers have a more rapid decline in FEV1% than non-smokers

but if smokers quit, the rate of decline returns to the normal rate of decline (even though they already lost some of the reserve)

6

What are some clinical presentations of COPD?

>20pack year history of smoking before symptoms.

morst common age of onset is in 5th decade with productive cough or acute chest illness

dyspnea on effort in 6th or 7th decade.

sputum in the AM and daily volume < 60 cc

acute chest illness=inc cough, purulent sputum, wheezing, dyspnea, and occasional fever

7

What are some PE findings associated with COPD?

With onset of disease only physical exam findings are: prolonged expiration & wheezing on forced expiration

As obstruction progresses, hyperinflation becomes evident, & the anteroposterior diameter of the chest increases causing barrel chest

Accessory muscles maybe used

Decreased heart & breath sounds

late stages: tripoding and cyanosis and an enlarged liver

8

What is a "blue bloater" vs "pink puffer"?

blue bloater =typical chronic bronchitis

pink puffer =emphysema

9

What x-ray findings are seen with COPD?

low, flat diaphragm on the lateral

enlarged retrosternal airspace

heart appears long and narrow with rapid tapering of vessels

cor pulmonale with right heart failure

10

What is stage I COPD?

mild

most pts
many are asymptomatic

FEV1/FVC 80% predicted

With or without chronic symptoms (cough, sputum production)

11

What is stage II COPD?

moderate

FEV1/FVC <70%

FEV1 50-80% predicted

With or without chronic symptoms (cough, sputum production)

12

What is stage III COPD?

severe

FEV1/FVC <70%

FEV1 30-50% predicted

With or without chronic symptoms (cough, sputum production)

13

What is stage IV COPD?

very severe

FEV1/FVC <50% predicted plus chronic respiratory failure or clinical signs of right failure

14

What are the goals of COPD management?

Reduce long-term lung function decline

Prevent & treat exacerbation

Reduce hospitalization

Reduce mortality

Relieve disabling dyspnea

Improve exercise tolerance & quality of life

15

What is the recommended treatment for mild COPD?

short acting bronchodilators as needed

16

What is the recommended treatment for moderate COPD?

long acting bronchodilators and short acting bronchodilators as needed

17

What is the recommended treatment for severe COPD?

corticosteroids
long acting bronchodilators and short acting bronchodilators as needed

18

What is the recommended treatment for very severe COPD?

oxygen, corticosteroids,
long acting bronchodilators and short acting bronchodilators as needed

19

What is the function of bronchodilators in the treatment of COPD?

quick symptom relief
relaxation of airway smooth mm --> dec hyperinflation --> less SOB

20

Which bronchodilator is the drug of choice for COPD and how does it work?

anticholinergic (short acting=ipratropium bromide with albuterlol or long acting =tiotropium-spiriva)
--> reduces vagal tone, inhibits cholinergic reflex bronchoconstriction, reduces mucous hypersecretion

SE: Paradoxical bronchoconstriction, glaucoma, bitter taste, dry mouth, urinary retention, constipation

21

What do inhaled corticosteroids improve? What is an important risk with ICS?

ICS reduces inflammation and the frequency of exacerbations by 15-20%

ICS modestly slows the progression of symptoms

Reduces the rate of decline in FEV1

Dysphonia & oral thrush are the most common adverse reactions

Increased risk of pneumonia

22

Is there a benefit associated with oral /IV steroids for exacerbations?

YES (unknown mechanism)

23

When should antibiotics be used in COPD exacerbations?

Worsening dyspnea, increase in cough/sputum volume, change in sputum color

24

What have studies shown about the use of macrocodes in COPD pts?

Use of macrolides has been shown to reduce the number of COPD exacerbations

Potential concerns are hearing loss, increased QT interval, tinnitus

25

What is the only drug shown to improve survival in hypoxemic pts with COPD?

long term oxygen therapy

helps to
-reverse secondary polycythemia
-increase body weight
-alleviate right heart failure due to cor pulmonale
-strengthen cardiac function
-enhance neuropsychological functions
-improve exercise performance and activities of daily living

26

What is the goal of oxygen therapy? Why should you avoid providing too much oxygen?

Goal of oxygen therapy is to achieve PaO2 > 55 mm Hg without drop of pH 7.25

too much oxygen can cause hypercarbia

27

When is pulmonary rehab recommended?

symptomatic COPD pts with FEV1 < 50%

--> improve exercise tolerance and symptoms of dyspnea and fatigue

28

What are the most common causes of COPD exacerbations? How should these be treated?

infections and air pollutions

systemic steroids (oral or IV) improved symptoms and lung function and decreased length of stay.

antibiotics may benefit those with signs of airway infection

29

When would a lung transplant be considered for COPD?

Age < 65

Low exercise tolerance

FEV1 <20%

No disease distribution requirements