COPD highlights

Question 1

List some common causes of chronic cough in adults

Answer 1

1) COPD
2) Smoking
3) Post infectious – CAP, bronchitis, etc.

Question 2

Who should be evaluated for COPD?

Answer 2

Symptomatic pts

Question 3

Give the onset, duration, and timing of COPD

Answer 3

1) Onset: slowly progressive, older adults
2) Duration: persistent, non-reversible
3) Timing: chronic with exacerbations – often associated with RTI

Question 4

True or false: Signs are neither sensitive or specific for COPD

Answer 4

True

Question 5

Bronchitis predominant:
1) What are some important things about how they generally present?
2) What drives their breathing?

Answer 5

1) Chronic productive cough, comfortable at rest, significant DOE
2) CO2 retainers (blue)

Question 6

Emphysema predominant:
1) What are some important things about how they generally present?
2) What drives their breathing?

Answer 6

1) “Pink puffers”; SOB at rest, minimal coughing
2) CO2 responsive/driven

Question 7

How would you Dx COPD in a patient with typical presentation (age, risk factors, symptoms)?

Answer 7

1) Spirometry/ PFT
2) Post SABA
3) FEV1/ FVC ratio <0.7 or 70%

Question 8

FEV1 % predicted [does/ does not] demonstrate improvement in COPD with SABA (unlike in asthma)

Answer 8

does not

Question 9

Particularly, __________ patients Dx with COPD should be tested for A1AT def

Answer 9

young

Question 10

True or false: regular spirometry generally can’t Dx COPD, it needs to be a post-SABA test

Answer 10

True

Question 11

True or false: There is nothing you can do as a provider to slow the progression of COPD other than providing them with home oxygen (if appropriate) and tell them to quit smoking

Answer 11

True

Question 12

What is the 1st line treatment in COPD patients still smoking?

Answer 12

Smoking cessation

Question 13

Varenicline (var EN i cline) (Chantix): When should you start this?

Answer 13

Starting in patients not ready to quit increases quit rate @ 6 months compared to waiting until ready to quit, NNT 6

Question 14

Starting _____________ in patients not ready to quit smoking increases quit rate @ 6 months compared to waiting until ready to quit, NNT 6

Answer 14

Varenicline (Chantix)

Question 15

True or false: all pts need a SABA unless it’s SMART therapy.

Answer 15

True (Symbicort is SMART bc it has formoterol)

Question 16

Pulmonary rehab is appropriate for which COPD pts?

Answer 16

Appropriate for patient groups B & E

Question 17

If ____________ is noted, then COPD patients benefit from long-term O2 therapy even if PaO2 > 55 mmHg or SpO2 > 88%

Answer 17

tissue hypoxia

Question 18

Long-term O2 therapy: Does not improve outcomes or QOL in ____________

Answer 18

exertional hypoxia

Question 19

Long term oxygen therapy recommended in COPD patients with __________________

Answer 19

Severe resting hypoxia

Question 20

What should you do prior to recommending surgery for a COPD pt?

Answer 20

Refer to pulmonologist

Question 21

How do you estimate COPD prognosis with validated tool?

Answer 21

BODE
BMI
Airflow Obstruction
Dyspnea
Exercise

Question 22

What is a key characteristic of moderate respiratory acidosis?

Answer 22

No acidosis

Question 23

What characterizes severe respiratory acidosis?

Answer 23

Prescence of acidosis

Question 24

How would you pharmacologically Tx moderate ECOPD?

Answer 24

SABA +/- SAMA and OCS +/- antibiotics

Question 25

For COPD, list how common the following Sx are: 1) Chronic cough and sputum 2) DOE or poor lung function 3) Onset prior to age 40 4) Tobacco use (dr mac said this chart is "worth spending a bit of time on” so I guess it's important?)

Answer 25

1) Common 2) Persistent 3) Uncommon 4) Almost always

Question 26

For COPD, list how common the following Sx are: 1) Airway hyper responsiveness 2) Progression 3) Identifiable triggers 4) Bronchodilator response ("worth spending a bit of time on”)

Answer 26

1) Common 2) Slow, little variability 3) Slow, little variability 4) Modest

Question 27

For Asthma, list how common the following Sx are: 1) Chronic cough and sputum 2) DOE or poor lung function 3) Onset prior to age 40 4) Tobacco use (dr mac said this chart is "worth spending a bit of time on” so I guess it's important?)

Answer 27

1) Variable 2) Intermittent, reversible 3) Common 4) Sometimes

Question 28

For Asthma, list how common the following Sx are: 1) Airway hyper responsiveness 2) Progression 3) Identifiable triggers 4) Bronchodilator response ("worth spending a bit of time on”)

Answer 28

1) Always 2) Episodic, variable 3) Common 4) Often marked

Question 29

Bronchiectasis: 1) What is it characterized by? 2) What is it? (just know it's a common denominator between pts that have chronic recurring resp. tract infections for Tues. exam)

Answer 29

1) Irreversible pathologic dilation & destruction of the bronchial walls 2) Chronic or recurring infectious process

Question 30

List some CXR findings of Bronchiectasis (not sure if on exam but it's highlighted)

Answer 30

1) Lack of tapering = Tram-track markings 2) Air-fluid levels may be seen in cystic bronchiectasis. 3) Generally = Dilated thickened airways and scattered irregular opacities