Dyspnea (Chronic Obstructive Pulmonary Disease) Flashcards Preview

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Flashcards in Dyspnea (Chronic Obstructive Pulmonary Disease) Deck (29):
1

Chronic bronchitis

Cough and sputum production on most days for at least 3 months during at least 2 consecutive years

2

SOB caused by the enlargement of respiratory bronchioles and alveoli caused by destruction of lung tissue

emphysema

3

COPD

airway obstruction that is NOT FULLY REVERSIBLE (unlike asthma), is usually progressive and is associated with chronic bronchitis or emphysema or both

usually presents mid to late in life, associated with heavy smoking history

4

If COPD occurs in age under 45 in someone who doesn't smoke, what is the likely (rarer) etiology?

a1-antitrypsin deficiency

5

Pathologic changes seen in COPD

mucous gland hypertrophy with hypersecretion, ciliary dysfunction, destruction of lung parenchyma, and airway remodeling

6

Physical symptoms of COPD

narrowing of airway, fixed airway obstruction, poor mucous clearance, cough, wheezing, and dyspnea

7

Progression of COPD symptoms

Cough (most common initlal symptom) first interittent then becoming a daily occurence, with change in mucus from clear to yellow/green and often wheezing (exacerbations caused often by bacterial/viral infection)...

then DYSPNEA that progressives over time; first with exertion, then little exertion, then at rest.

8

By the time dypsnea develops in COPD what is the FEV/FVC rate?

less than 50%

9

Ddx for dyspnea

COPD
CHF
asthma
interstitial lung disease
pneumonia
psychogenic (anxiety)

10

Physical exam findings for severe COPD

- barrel chest and distant heart sounds (increased anteriorposterior diameter due to hyperinflation)
-expiratory wheezing
- prolonged expiratory phase
- tachypnea, anxiety, use of accessory muscles during acute exacerbation
- may have signs of cyanosis (perioral or digits)

11

Chest x ray in COPD

initially normal until disease progresses

increased PA diameter, flattening of diaphragm, bullae (areas of parenchymal destruction)

12

What happens to FVC and FEV1 in COPD

Both are reduced and ratio is less than 0.7

Reversibility (greater than 12% improvement or 200 mL with bronchodilator) is NOT seen on spirometry indicating fixed obstruction

13

What components of treatment are common to all stages of COPD?

- SMOKING CESSATION (slows detrioration)
- pneumococcal and influenza vaccines to prevent exacerbations
- regular exercise and weight control
- avoiding environmental triggers (pollution, occupational exposures, second hand smoke)

14

Stage 0 COPD

- at risk
- cough, sputum production, normal spirometry
- vaccines and address risk factors

15

Stage I COPD

-mild COPD
- FEV1/FVC 80% predicted, with or without symptoms
- short acting bronchodilators

16

Stage II COPD

- moderate COPD
- FEV1/FVC

17

Stage III COPD

-severe COPD
- FEV1/FVC

18

Stage IV COPD

- very severe COPD
- FEV1/FVC

19

Examples of short acting bronchodilators

b2 agonists like albuterol and muscarinc antagonists like ipratropium

20

Examples of long acting bronchodilators

salmeterol (b2 agonist), tiotroprium (anticholinergic)....more expensive

21

Recommended treatment for COPD III and IV that reduce frequency of exacerbations

inhaled steroids (flucitasone, triamcinolone, mometasone)

22

What is the only intervention that has been shown to decrease mortality and must be worn for at least 15 hr/day?

o2 therapy reserved for stage IV COPD

23

Best way to monitor lung function as COPD progresses?

spirometry

24

Signs of COPD exacerbation

increased dyspnea, change in sputum color/amount, cough, wheezing

25

Common triggers for COPD exacerbation

viral/bacterial infxn (most common), air pollutants, second hand smoke

26

Diagnoses similar to COPD

PE, CHF, MI, pneumonia, pneumothorax, pleural effusion

27

Treatment for acute exacerbations

short acting bronchodilators (combos with different mechanisms)

28

T/F: Systemic steriods do not shorten the course of exacerbations

FALSE THEY DO and they reduce risk of relapse

29

most common bacteria implicated in COPD exacerbations

pneumococcus, haemophilus influenza, moraxella catarrhalis

sputum culture should be performed!