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Flashcards in Respiratory 3 Deck (79):
1

reversible airflow obstruction, different phenotypes, inflammation prominent

asthma

2

permanent, enlargement/destruction of the respiratory bronchioles

Emphysema/ COPD

3

Enlarged airways from chronic infection or abnormal cilia function--CF

Bronchiectasis

4

sputum production 3 months/year for 2 years

Chronic Bronchitis

5

In an obstructive defect, what decreases more FEV1 or FVC?

FEV1
ratio of FEV1/ FVC is decreased

6

What must FEV1/FVC be decreased to for an obstructive lung dz?

70%

7

Is COPD preventable?

Yes, and treatable!

8

If spirometery is FEV1 >80% what severity is COPD?

Mild

9

50%<80% indicates what severity of COPD

moderate

10

30%< ____<50% indicates what severity of COPD

severe

11

what is very severe COPD

<30% FEV1 predicted value

12

what is a rare inherited deficiency that causes emphysema due to homozygous genetic mutation.

alpha-1 protease inhibitor deficiency

13

what does cigarette smoking cause?

oxidative stress which leads to inflammation
epithelial permeability
injury

14

what does mucociliary dysfunction lead to?

Mucus hypersecretion
reduced mucociliary transport
mucosal damage

15

what cells increase in COPD and destroy things?

CD8+ T lymphocytes
Monocytes/ macrophages
Neutrophils
Mast cells
inflammatory mediators
proteases

16

what structural changes happen w/ COPD

globlet cell hyperplasia/ metaplasia
mucous gland hypertrophy
increased smooth muscle mass
airway fibrosis
alveolar dystruction

17

what are systemic components of COPD?

Poor nutritional status
Reduced BMI
impaired skeletal muscle
weakness
wasting

18

what airflow limitations are there with COPD?

loss of alveolar attachments
loss of elastic recoil
increased smooth muscle contraction

19

does a skinny or fat COPD patient do better?

Fat

20

Will the liver be palpable with COPD?

Yes, due to hyperinflation

21

what will the thorax sound like to percussion with COPD?

Hyperresonance

22

where will wheezing be heard on COPD?

Forced expiration

23

Where are heart sounds best heard on COPD patient?

over xiphoid area

24

Is an ABG helpful with COPD?

Doesn't help with diagnosis or prognosis

25

what causes polycythemia is patients with COPD?

low oxygen content

26

why may there be an elevated serum bicarbonate with COPD?

secondary to CO2 retention

27

what is a normal FEV1?

3.2-3.5 (a galloon)

28

what COPD drug may stimulate respiratory center, improve muscle function. (not used often)

Theophylline

29

what is the most important thing for COPD tx?

smoking cessation

30

apart from quitting smoking, what is the only therapy that helps reduce mortality with COPD?

oxygen therapy

31

If a pulse ox is less than what do they qualify for oxygen?

88%

32

what do all patients w/ COPD need?

influenza shot
SABA PRN

33

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

34

when do you add inhaled glucocorticosteroids for COPD?

Severe, FEV1 is between 30-50% predicted

35

When do you add long term oxygen or consider surgical options for COPD?

FEV <50% predicted with chronic respiratory failure

36

does response to bronchodilator during spirometry challenge predict whether or not a patient will benefit from long term use?

No

37

what do anticholinergics do?

"toners" prevent the airway from closing

38

what is the onset of effect of albuterol?

1-3 minutes

39

what is the duration of action of albuterol?

4-6 hours

40

what drug inhibits acetylcholine interaction with M3 receptors- decrease smooth muscle tone

Ipratropium

41

Onset of action of ipratropium

60-90 minutes

42

AN MDI with spacer is just as effective as what?

Nebulizer

43

is ipratropium maintence therapy?

Yes

44

Duration of action of ipratropium?

4-6 hours

45

___________ more efficacious than SABA when added to ipratropium for stable COPD

LABA

46

what do LABAs do to help COPD?

Decrease airflow obstruction, dynamic hyperinflation
decreased frequency and severity of symptoms
improved QOL

47

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

Tiotropium

48

Anticholinergic with affinity for musacrinic receptor. Reaches steady state after 10 minutes with 1/2 life of 5-8 hours. 1 puff BID

Aclidinium (Tudorza)

49

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

50

is there any effect on inhaled steroids with preventing FEV1 decline?

No, but may decrease number of exacerbations

51

what do inhaled steroids have an associated with?

Hip fractures

52

what together help improve airway obstruction, decrease dyspnea, use of SABA and overall health status?

LABAs and inhaled corticosteroids

53

Is a combination therapy an issue with COPD?

No, can be beneficial

54

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

Phosphodiesterase-4 inhibitors

55

side effects of phosphodiesterase-4 inhibitors

Diarrhea
weight decrease

56

what can oxygen therapy help with?

Prevent pulmonary HTN
improve IQ scores, general alertness
Increase endurance
Reverse polycythemia

57

A person who is under 65 and their FEv1 is what can get Pneumovax?

FEV1 <40%

58

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

COPD exacerbation

59

best COPD mortality predictor?

Hospitalization last year

60

when do you give someone with COPD oxygen?

O2 Sat less than 87%

61

how long should steroids be with exacerbations of COPD

2 weeks

62

should you use abx with COPD when they have an exacerbation?

Yes

63

What should a person with COPD be given for when they have an exacerbation

Steroids PO
Antibiotics PO

64

how many Liters can nasal cannula administer?

6 L/ min (humidify at 4 L or greater)

65

per liter how much percentage oxygen increase do you get?

3-4 % increase

66

Is an abnormal dilatation of the bronchial tree
Can be either acquired or congenital

Bronchiectasis

67

what is bronchiectasis linked to?

Pertussis and measles
can occur post TB

68

how much of the medication from a MDI go into the lung?

10% (increases with a spacer)

69

what does brochiectasis cause distally?

Causes scarring & obstruction & mucus/ pus accumulation

70

what could bronchiectasis eventually lead to?

right ventricular failure/ respiratory failure

71

congentital causes of bronchiectasis

ciliary dysfunction syndromes
cystic fibrosis
primary hypogammaglobulinemia

72

acquired causes of bronchiectasis in children

Pneumonia
TB
foreign object

73

Acquired causes of bronchiectasis in adults

suppurative pneumonia
TB
allergic bronchopulmonary aspergillosis
bronchial tumors

74

symptoms of bronchiectasis

chronic cough, purulent in the morning
copious discharge
fever, malaise, pleurisy
hemoptysis

75

constitutional symptoms associated w/ bronchiectasis

weight loss
poor appetite

76

best imaging for bronchiectasis

High resolution CT

77

what may be needed for people with hemoptysis with bronchiectasis

Surgical resection of localized areas

78

Frequently has GI sx, failure to thrive, early respiratory infections, meconium ileus
Typically develop severe bronchiectasis, upper lobe initially

Cystic fibrosis

79

men with CF usually lack a what?

Vas deferenes (infertile)