COPD Lecture Powerpoint

Question 1

COPD is the ___ leading cause of death, and its mortality rates are not ____

Answer 1

4th, decreasing

Question 2

Leading cause of COPD

Answer 2

Smoking

Question 3

COPD risk with age, gender, and socioeconomic status

Answer 3

Increases with age, equal between genders, low socioeconomic status associated with higher risk

Question 4

Asthma COPD Overlap syndrome

Answer 4

Refers to fact that patients with asthma have 10-30 fold increased risk of developing COPD as well resulting in features associated with asthma and COPD both in a patient

Question 5

COPD development younger than 40 years old could indicate….

Answer 5

….alpha 1 anti-trypsin deficiency

Question 6

Smokers with a history of more than 40 pack years are at high risk for…

Answer 6

…COPD

Question 7

Pack year

Answer 7

Clinical quantification of cigarette smoking used to determine exposure to tobacco and assess risk of developing pathology related to smoking, calculated by (cigs avg. smoked per day/20cigs/pack)*#YEARS smoked

Question 8

COPD pathophysiology

Answer 8

Chronic irritation and air inflow limitation resulting in gas exchange abnormalities resulting in acidotic status (retention of CO2) that can see mucus hypersecretion, pulmonary vascular changes and scarring, and systemic effects such as osteopenia or anxiety

Question 9

Patients with COPD that have ____ have a higher mortality rate

Answer 9

acute exacerbations

Question 10

3 types of COPD

Answer 10

• Emphysema
• chronic bronchitis
• non reversible asthma (asthma COPD overlap syndrome)

Question 11

Chronic bronchitis defining characteristic

Answer 11

-Increased mucus and inflammation in terminal bronchioles

Question 12

Emphysema defining characteristic

Answer 12

-A loss of lung elasticity and destruction of lung parenchyma that sees destruction and enlargement of alvelolar sacs distal to terminal bronchioles that leads to acidotic state due to CO2 buildup

Question 13

Chronic bronchitis diagnosis

Answer 13

Clinical diagnosis of a productive cough lasting at least 3 months in 2 consecutive years for which other causes have been excluded, irreversible condition where patients see hyperplasia and hypertrophy of goblet cells and mucus glands causing sputum buildup and narrowing of airways limiting airflow

Question 14

Most patients have what type of COPD?

Answer 14

Overlap of emphysema and chronic bronchitis

Question 15

Blue bloater syndrome

Answer 15

Refers to how chronic bronchitis patients often present, as overweight and cyanotic

Question 16

Pink puffer syndrome

Answer 16

Refers to how emphysema patients often present, thin due to weight loss and muscle wasting and flattened diaphragm as they puff air and develop a reddish complexion

Question 17

4 classic symptoms of COPD

Answer 17

• Chronic cough
• sputum production
• Dyspnea on exertion
• fatigue

Question 18

Supplementary signs/symptoms of COPD (3)

Answer 18

• Increased AP diameter
• prolonged expiratory phase of respiration
• hyperresonance pattern on chest

Question 19

Patients that present with clubbing of fingers and COPD is often indicative of….

Clubbing of the digits alone is typically not seen in….

Answer 19

…lung cancer

….COPD patients

Question 20

Characteristics of late stage COPD (4)

Answer 20

• skeletal muscle wasting
• JVD and peripheral edema due to right sided heart failure (cor pulmonale) and resultant pulmonary hypertension
• tripoding
• polycythemia (measured CBC with diff)

Question 21

Severe respiratory infections as a child can increase propensity of developing…

Answer 21

….COPD

Question 22

2 common comorbid conditions in COPD patients

Answer 22

• depression

- Heart failure

Question 23

PE findings of COPD (note that a PE for COPD is rarely diagnostic in itself) (4)

Answer 23

• shallow rapid breathing
• barrel shaped chest
• hyperresonance on percussion
• diminished breath sounds

Question 24

Confirmatory diagnostic test to diagnose suspected COPD

Answer 24

Spirometry, most important value is FEV1/FVC ratio less than .70 is diagnostic***, performed pre and post bronchodilator to rule out asthma (minimally changes in COPD)

Question 25

“Half moon” pattern on a PFT volume/flow graph is associated with….

Answer 25

…Obstructive lung disease such as COPD

Question 26

Classification of COPD (4)

Answer 26

Based on FEV1

• class 1 is FEV>80% (patient unaware)
• class 2 FEV 50-80%
• class 3 FEV1 30-50%
• class 4 FEV1 <30% (will have barrel chest and look very very sick with terrible quality of life)

Question 27

Other labs for COPD (5)

Answer 27

• CXR
• ABG
• a1 antitrypsin indicated for all COPD patients at least once
• BNP
• CBC

Question 28

Fundamental principle goals of COPD treatment (3)

Answer 28

• prevent progression
• reduce exacerbations
• treat complications

Question 29

COPD patients require _____ vaccines to limit….

Answer 29

flu and pneumococcal,

…limits risk of exacerbation of symptoms

Question 30

Common 4 meds used in COPD

Answer 30

• inhaled short acting bronchodilators
• long acting bronchodilators
• inhaled glucocorticoids
• theophyline (oral bronchodilator more side effects used in refractory cases)

Question 31

What only 2 treatments have been shown to improve survival of COPD patients? What are pharmacological treatments considered?

Answer 31

• Smoking cessation and o2 therapy

- relief of symptoms (palliative)

Question 32

Inhaled bronchodilators for COPD

Answer 32

Bring short acting relief of symptoms in all stages of COPD and act either as a anticholinergic or B2 agonist

Question 33

Combivent function

Answer 33

A combined anticholinergic and B2 agonist (Ipratropium and albuterol) used in short acting relief for acute COPD exacerbation

Question 34

Inhaled corticosteroids for COPD and what is one side effect?

Answer 34

• Treatment for 3rd stage or more severe COPD alongside short and long acting bronchodilators
• can often cause oral thrush as a side effect

Question 35

Roflumilast (daliresp) function

Answer 35

New medication that is a selective PDE4 inhibitor useful to reduce risk of COPD exacerbation in patients with severe COPD that cannot tolerate corticosteroids (not a bronchodilator used for acute bronchospasm)

Question 36

When is pulmonary rehab recommended for COPD patients?

Answer 36

For symptomatic patients with FEV1 <50% predicted (class 3 or higher COPD)

Question 37

Oxygen therapy for COPD patients

Answer 37

Used in severe COPD or exacerbations either continuously, during exercise, or to relieve acute dyspnea

Question 38

COPD exacerbations

Answer 38

Episodic increase in frequency and severity of cough, increase in volume production and changes in character, and dyspnea increasing most often due to acute bacterial infections (up to 10% fatal due to already impaired functioning at rest)

Question 39

Regardless of mild or severe COPD exacerbations, these 4 things are indicated

Answer 39

• Antibiotics (culture and amoxicillin)
• bronchodilators
• inhaled corticosteroids
• potentially o2 therapy

Question 40

Lung parenchyma definition

Answer 40

The respiratory bronchioles, alveolar ducts, and sacs (areas of the lung involved in its primary function of gas exchange)

Question 41

Emphysema effects the _____, different from chronic bronchitis

Answer 41

Lung parenchyma

Question 42

Surgical intervention for COPD patients is recommended for what group?

Answer 42

Younger patients with a life expectancy <2 years without the intervention

Question 43

Lung volume reduction surgery function

Answer 43

Remove damaged parts of the lung to reduce hyperinflation and improve effectiveness of respiratory muscles and elastic recoil ability of lungs