Flashcards in Respiratory 3 Deck (79):
reversible airflow obstruction, different phenotypes, inflammation prominent
permanent, enlargement/destruction of the respiratory bronchioles
Enlarged airways from chronic infection or abnormal cilia function--CF
sputum production 3 months/year for 2 years
In an obstructive defect, what decreases more FEV1 or FVC?
ratio of FEV1/ FVC is decreased
What must FEV1/FVC be decreased to for an obstructive lung dz?
Is COPD preventable?
Yes, and treatable!
If spirometery is FEV1 >80% what severity is COPD?
50%<80% indicates what severity of COPD
30%< ____<50% indicates what severity of COPD
what is very severe COPD
<30% FEV1 predicted value
what is a rare inherited deficiency that causes emphysema due to homozygous genetic mutation.
alpha-1 protease inhibitor deficiency
what does cigarette smoking cause?
oxidative stress which leads to inflammation
what does mucociliary dysfunction lead to?
reduced mucociliary transport
what cells increase in COPD and destroy things?
CD8+ T lymphocytes
what structural changes happen w/ COPD
globlet cell hyperplasia/ metaplasia
mucous gland hypertrophy
increased smooth muscle mass
what are systemic components of COPD?
Poor nutritional status
impaired skeletal muscle
what airflow limitations are there with COPD?
loss of alveolar attachments
loss of elastic recoil
increased smooth muscle contraction
does a skinny or fat COPD patient do better?
Will the liver be palpable with COPD?
Yes, due to hyperinflation
what will the thorax sound like to percussion with COPD?
where will wheezing be heard on COPD?
Where are heart sounds best heard on COPD patient?
over xiphoid area
Is an ABG helpful with COPD?
Doesn't help with diagnosis or prognosis
what causes polycythemia is patients with COPD?
low oxygen content
why may there be an elevated serum bicarbonate with COPD?
secondary to CO2 retention
what is a normal FEV1?
3.2-3.5 (a galloon)
what COPD drug may stimulate respiratory center, improve muscle function. (not used often)
what is the most important thing for COPD tx?
apart from quitting smoking, what is the only therapy that helps reduce mortality with COPD?
If a pulse ox is less than what do they qualify for oxygen?
what do all patients w/ COPD need?
when do COPD patients need regular tx with one or more LABA PRN and rehab?
Moderate COPD FEV1 is b/w 50 and 80% predicted
when do you add inhaled glucocorticosteroids for COPD?
Severe, FEV1 is between 30-50% predicted
When do you add long term oxygen or consider surgical options for COPD?
FEV <50% predicted with chronic respiratory failure
does response to bronchodilator during spirometry challenge predict whether or not a patient will benefit from long term use?
what do anticholinergics do?
"toners" prevent the airway from closing
what is the onset of effect of albuterol?
what is the duration of action of albuterol?
what drug inhibits acetylcholine interaction with M3 receptors- decrease smooth muscle tone
Onset of action of ipratropium
AN MDI with spacer is just as effective as what?
is ipratropium maintence therapy?
Duration of action of ipratropium?
___________ more efficacious than SABA when added to ipratropium for stable COPD
what do LABAs do to help COPD?
Decrease airflow obstruction, dynamic hyperinflation
decreased frequency and severity of symptoms
What is an anticholinergic with once-daily dosing, LABA. More selectively for muscarinic sub-types than ipratropium? Onset of action 30 minutes, peak 3 hours after dose
Anticholinergic with affinity for musacrinic receptor. Reaches steady state after 10 minutes with 1/2 life of 5-8 hours. 1 puff BID
what must you do with a COPD patient on oral corticosteroids?
2 week steroid trial with documented improvement on PFTs to justify long term use
is there any effect on inhaled steroids with preventing FEV1 decline?
No, but may decrease number of exacerbations
what do inhaled steroids have an associated with?
what together help improve airway obstruction, decrease dyspnea, use of SABA and overall health status?
LABAs and inhaled corticosteroids
Is a combination therapy an issue with COPD?
No, can be beneficial
what is a pill that is taken once a day for patients with severe COPD (FEV1 <50%) and frequent exacerbations. Leads to increased intracellular cAMP
side effects of phosphodiesterase-4 inhibitors
what can oxygen therapy help with?
Prevent pulmonary HTN
improve IQ scores, general alertness
A person who is under 65 and their FEv1 is what can get Pneumovax?
Acute event characterized by worsening of the patient’s respiratory symptoms that is beyond normal day-to day variations and leads to change in medication
best COPD mortality predictor?
Hospitalization last year
when do you give someone with COPD oxygen?
O2 Sat less than 87%
how long should steroids be with exacerbations of COPD
should you use abx with COPD when they have an exacerbation?
What should a person with COPD be given for when they have an exacerbation
how many Liters can nasal cannula administer?
6 L/ min (humidify at 4 L or greater)
per liter how much percentage oxygen increase do you get?
3-4 % increase
Is an abnormal dilatation of the bronchial tree
Can be either acquired or congenital
what is bronchiectasis linked to?
Pertussis and measles
can occur post TB
how much of the medication from a MDI go into the lung?
10% (increases with a spacer)
what does brochiectasis cause distally?
Causes scarring & obstruction & mucus/ pus accumulation
what could bronchiectasis eventually lead to?
right ventricular failure/ respiratory failure
congentital causes of bronchiectasis
ciliary dysfunction syndromes
acquired causes of bronchiectasis in children
Acquired causes of bronchiectasis in adults
allergic bronchopulmonary aspergillosis
symptoms of bronchiectasis
chronic cough, purulent in the morning
fever, malaise, pleurisy
constitutional symptoms associated w/ bronchiectasis
best imaging for bronchiectasis
High resolution CT
what may be needed for people with hemoptysis with bronchiectasis
Surgical resection of localized areas
Frequently has GI sx, failure to thrive, early respiratory infections, meconium ileus
Typically develop severe bronchiectasis, upper lobe initially