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Flashcards in COPD, Lung CA, OSA Deck (18):
1

A post-bronchodilator PFT is diagnostic of airflow limitation and confirms COPD

FEV1/FVC<0.7 associated with an FEV1 <80%

2

COPD staging based on spirometry - Gold

STAGE / GOLD: based on post-bronchodilator FEV1/FVC <0.7
I (mild) FEV1 >80% predicted
II (moderate) FEV1 <80% predicted
III (severe) FEV1 <50% predicted
IV (very severe) FEV1 <30% predicted

3

COPD staging based on spirometry - ATS/ERS

STAGE / ATS/ERS
0 smokers with symptoms FEV1/FVC>0.7 FEV1 >80% predicted
I (mild) FEV1/FVC<=0.7 FEV1 >80% predicted
II (moderate) FEV1/FVC<=0.7 FEV1 50-79% predicted
III (severe) FEV1/FVC<=0.7 FEV1 30-49% predicted
IV (very severe) FEV1/FVC<=0.7 FEV1 <30% predicted

4

COPD management

mild disease FEV1>80%
SABA q2-6 hrs prn
moderate disease FEV 50-79%
LABA or tiotropium. If not effective, trial of ICS.
severe disease FEV1 30-49%
O2, pulmonary rehab, all previously mentioned meds. (theophylline in severe disease), lung volume reduction surgery, transplant

5

Classification of COPD exacerbations by severity

mild - can be controlled with an increase in dosage of regular medications
moderate - requires treatment with systemic corticosteroids or antibiotics
severe - requires hospitalization or ED evaluation

6

USPSTF December 2013 diagnostic testing

annual low dose lung CT scans in those with a >30 pack year, age 55-80. Can stop screening if patient has quit smoking for 15 years.

7

Acute COPD exacerbations treatment

1) O2 sats 80-90%, titrate with O2 to 90%
2) ABG evaluation if <80% O2 sats and pH<7.32
3) antibiotics - 1st line (amoxicillin, TMP/SMX, macrolides, doxycycline). 2nd line (2nd or 3rd cephalosporins, amoxicillin/clavulanate, doxycycline)
4) bronchodilators - albuterol (inhaled anticholinergics produce additive bronchodilation.
5) systemic steroids - 30-60 mg daily for 10-14 days. Longer duration needs tapering. No need to stop inhaled steroids

8

Sleep Apnea Diagnosis

mild - AHI 5-15
moderate - AHI 15-30
severe - >30

9

Absolute risk of COPD among active continuous smokers

at least 25%

10

How many times more likely to die from COPD than non-smokers

12-13x

11

Medical Research Council (MRC) Dyspnea Index

Grade 1-5

12

BODE index

FEV1
distance walked in 6 minutes
grade on the MRC dyspnea scale
BMI

13

Single best variable for identifying adults with COPD

>40 pack years of smoking

14

Smoking cessation couseling

Ask
Advice
Assess
Assist
Arrange

15

When are antibiotics given in acute COPD exacerbation?

1) With all 3 symptoms: increased dyspnea, increased sputum volume, purulence
2) Only 2 symptoms, if one of them is increased purulence of sputum.
3) if hospitalized for COPD and mechanical ventilation (invasive or non-invasive) is required

16

Most common symptom in COPD

1) cough
2) exertional dyspnea
3) increased sputum production

17

Leading causes of death

1st - cardiovascular
2nd - lung CA
3rd - COPD

18

Antibiotics should be given in acute COPD exacerbation with all 3 symptoms present

1) increased dyspnea
2) increased sputum volume
3) increased sputum purulence