Johns: Shortness of Breath Flashcards
(34 cards)
What is COPD?
Airflow limitation that is NOT fully reversible.
Associated w/ abnormal INFLAMMATORY response of the lungs.
What is the most important lung disease in the US and the 4th ranked cause of death?
COPD
What is chronic bronchitis?
Chronic PRODUCTIVE COUGH for THREE months in TWO successive years
What is emphysema?
Enlargement of airspaces w/ destruction of bronchiole walls
What is asthma?
INFLAMMATORY disease of airways w/ significantly REVERSIBLE narrowing
What are the clinical features of COPD?
LONG TERM PROCESS
Pts have SMOKED at least 20 cigarettes per day for 20 or more years.
Starts w/ CHRONIC COUGH.
DYSPNEA doesn’t occur until 10-20 years later.
A pt presents with chronic cough, chronic sputum production, and dyspnea. they are also a smoker. What may they have?
COPD
How do you differentiate asthma from COPD?
Asthma- completely reversible w/ bronchodilators
COPD- completely irreversible
What are clinical features as COPD progresses?
Chronic clear sputum production Weight loss Morning HA (caused by hypoxemia) Hypercapnia w/ hypoxemia Cor pulmonale (RHF)
What is the clinical course of airway function in COPD vs. Asthma?
FEV1 decreases w/ Age/Asthma
FEV1 drops off DRAMATICALLY
On physical examination, a pt has prolonged expiration, hyperinflation of the lungs (increased AP diameter d/t trapped air), hyperresonent to percussion (sound like a drum), depressed diaphragm, decreased breath sounds, and wheezes. What does this suggest?
COPD
What is indicative of end stage COPD?
Accessory muscles pursed lips cyanosis enlarged liver asterixis (tremor of the hand when wrist is extended)
How do you diagnose COPD?
CXRAY
Chest CT
Pulmonary function tests
What is seen on pulmonary function tests in a pt w/ COPD?
Decreased FEV1
Decreased FEV1/FVC
Increased TLC
Absence of bronchodilator response
What is seen on a CXRAY of a pt w/ obstructive lung disease?
Hyperlucent lung fields
Flat diaphragm
Little lung tissue
Lateral- increased AP diameter from air trapping over time (also seen in a pt w/ bad asthma)
What is seen on spirometry of a pt w/ COPD?
Significantly decreased FEV1– can’t blow out as much air in the fist second
FVC- is fairly normal or larger than normal
*How do you tell the difference between COPD and asthma?
Spirometry test
Give bronchodilator and repeat spirometry test again. If there is significant change that it’s Asthma.
How do you manage stable COPD?
SMOKING CESSATION–> will cause FEV1 to decline
What is a beta 2 agonist bronchodilator?
Albuterol metered dose inhaler
What anticholinergic agents are used to treat COPD?
Inhaled ipratropium
What’s in most inhalers?
Anticholinergics and beta agonists
*these are also the MOST EFFECTIVE
Why don’t we use theophylline much anymore?
Toxicity
When do we use corticosteroids to treat COPD?
Mainly short term for exacerbations and only if all other meds are at maximal therapy
May slow rate of decline of FEV1
When is supplemental O2 used to treat COPD?
If O2 sat is below 88% or if room air falls below 85%
If cor pulmonale is present
*O2 helps sxs and prevents cor pulmonale
