January 21, 2016 - COPD Flashcards Preview

COURSE 3 > January 21, 2016 - COPD > Flashcards

Flashcards in January 21, 2016 - COPD Deck (19):

COPD - Definition

Respiratory disorder largely caused by smoking, and is characterized by progressive, partially reversible airway obstruction and lung hyperinflation, systemic manifestations, and increasing frequency and severity of exacerbations.


Cost of COPD to the System

COPD ranges from 1st to 5th most common cause of admission to hospitals.

Mean length of hospital stay for AECOPD was 11 days.

Estimated cost per stay was $10,000.


Screening for COPD

Does not make feasable sense to screen asymptomatic individuals

If a smoker or ex-smoker presents with any of the below, send them for spirometry:

- Coughing regularly

- Coughing up phlegm regularly

- Simple chores making you short of breat

- Wheezing during exertion

- Get frequent colds that last longer


Diagnosing COPD

Spirometry is essential.

FEV1/FVC of <0.7

Look at post-bronchodilator FEV1


DDx for COPD


Central airway obstruction (cancer, lymphadenopathy, central airway stenosis)

Heart Failure



Obliterative bronchiolitis

Diffuse Pan bronchiolitis


Risk Factors for COPD

Smoking (20-50% of smokers will develop significant COPD)

Other risks include occupational exposures


Inflammation in COPD

COPD is a low-grade inflammatory disease of the lungs with systemic manifestations.

In the systemic circulation, there are increased levels of activated inflammatory cells, and increased levels of pro-inflammatory cytokines such as TNF-a, IL-8, and LT-B4.


Flow Limitation

Compare these two. Normally, there will be a gap between regular breathing and the line of maximum expiration. The area in between indicates there is no flow-limitation.

In patients with COPD, regular breathing is the same rate of expiration as in maximum expiration, and they are flow-limited.

A image thumb

"Scoop" in Flow-Volume Curve

A image thumb


Black holes.

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Dynamic Hyperinflation

You need to take another breath before you are finished exhaling the previous breath often due to an obstructive airway problem.


A image thumb

Management of COPD

Determine severity using spirometry, symptoms, and history

Diagnose and manage comorbidities

Non-pharmacologic and pharmacologic treatment


Determination of COPD Severity


Mild: FEV1 > 80% predicted, FEV1/FVC <0.7

Moderate: 50% < FEV1 < 80% predicted, FEV1/FVC <0.7

Severe: 30% < FEV1 < 50% predicted, FEV1/FVC <0.7

Very Severe: FEV1 < 30% predicted, FEV1/FVC <0.7


Mild: SOB from COPD when hurrying on the level, or walking up a hill

Moderate: SOB from COPD causing the patient to stop walking after 100m

Severe: SOB from COPD resulting in being too breathless to leave home


Non-Pharmacologic Treatment

Patient education

Effective inhaler technique

Smoking cessation

Early recognition and treatment of acute exaberations

Pulmonary rehab

End-of-life care


Vaccinations and COPD

It is very important for patients with COPD to be up-to-date on their vaccinations.

Getting sick can trigger an acute exaberation of their COPD.


Pharmacologic Treatment







* No role for ICS alone *


Asthma vs COPD

Age of onset - asthma is usually younger, but COPD is usually >40

Smoking - asthma is not causal, but COPD is usually >10 pack years

Sputum production - infrequent in asthma, often in COPD

Allergies - often in asthma, infrequent in COPD

Disease course - stable (with exaberations) in asthma, progressive in COPD

Spirometry - often normalizes in asthma, does not normalize in COPD


Acute Exacerbation of COPD (AECOPD)

Acute worsening of COPD symptoms beyond day-to-day variations. This includes an increase in dyspnea, an increase in cough, a change in sputum production.

Basically a "COPD flare".

50% of patients who are hospitalized from an episode of AECOPD are dead within 4 years.


Management of AECOPD

Increased doses of inhaled SABA and inhaled anticholinergic medication.

Oral or parenteral corticosteroids.

Antibiotics for new increased expectoration of mucopurulent sputum and dyspnea.

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