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Session 2 CM pulm5
CM- pulm -5- COPD
| Question | Answer |
|---|---|
| Is COPD curable | COPD is not curable but treatable and preventable |
| How would you characterize COPD | COPD is an airflow limitation that is not fully reversible and progressive associated with an abnormal inflammatory response |
| What is the difference from chronic bronchitis and emphysema | emphysema= destruction of alveoli chronic bronchitis= presence of cough with sputum for at least 3 months in each of 2 consecutive years |
| What does chronic inflammation of lungs lead to | structural changes, narrowing of airways and destruction of lung parenchyma |
| What are the causes of death in patients with COPD | cardiovascular diseases lung cancer respiratory failure w/ advanced COPD |
| what percents of adults over 40 have airflow limitation | 1/4 |
| What is a DALY | disability adjusted life year, |
| What is one of the problems with COPD in regards to epidemiology | underrecognition and underdiagnosis leads to significant underreporting |
| What are some of the risk factors for COPD | alpha-1 antitrypsin deficiency= early COPD Inhalation- smoking, occupation dusts and chemical, indoor air pollution Lung Growth and Development oxidative stress infections asthma socioeconomic status nutrition gender |
| What is the pathophysiology of COPD | inhaled particles(smoke other noxious particles) cause inflammation Abnormal response cuases parenchymal tissue destruction disrupts normal repair and defenses leads to airway fibrosis leads to air trapping and progressive airflow limitation |
| What airways can be effected in COPD | everyone proximal, peripheral airways, lung parenchyma and pulmonary vasculature |
| What can amplify lung inflammation in COPD | oxidative stress and excess proteases in the lung |
| What are the physiological changes in COPD | mucus, airflow limitation, air trapping, gas exchange abnormalities, cor pulmonale |
| What type of airflow disease is COPD obstructive or restrictive | obstructive |
| What systemic changes can you see in COPD | cachexia, skeletal muscle wasting, increased cardiovascular disease, anemia, osteoporosis, depression |
| In COPD will you have increase or decreased residual volume | increased residual volume |
| will you see increased or decreased total lung capacity in COPD | increased total lung capacity |
| Will you see hyper or hypo infaltion in COPD | hyperinflation |
| IF you get a patient to stop smoking will they regain normal lung function | NO but they will revert to a normal natural decline |
| What are the s/sx of COPD | dyspnea that is progressive, worse w/ exercise, persistent Chronic Cough sputum production history of exposure to risk factors (smoking, dusts, chemicals) |
| What is the typical onset of COPD vs Asthma | COPD mid-life vs Asthma Early in life (childhood) |
| What is the difference in symptoms between COPD vs Asthma | COPD- slowly progressive Asthma- Vary from day to day and peak in the night/early morning |
| What are the inflammatory cells seen in COPD vs Asthma | COPD- Neutrophils Asthma- Eosinophils |
| What is the diffence in airway hyper-responsivness in COPD and Asthma | COPD- Absent Asthma-present |
| What is the difference in regards to airflow limitation in COPD vs Asthma | largerly irreversible largerly reversible |
| Looking for COPD what would you want to do during percussion of lungs | get a diaphragmatic excursion |
| What would you see on auscultation of COPD | reduced breath sounds maybe inspiratory wheezes or crackles |
| What would you need to get to help diagnose COPD | spirometry |
| What would you see in FEV1, FEV1/FVC ration, in COPD | Both would be reduced |
| What would see in a DLCO with COPD | reduced DLCO |
| What would be the lab findings with a patient suffering from COPD with an ABG draw | assesses development of respiration failure PaO2 < 60mmHg + PaCO2 >50mmHg pulse ox <92% |
| What will you see in HCT lab of COPD patient | polycythemia hct >55% 1/4 patients actually have anemia |
| What would you see on a Chest X-ray with COPD | flat diaphragm elongated heart increased retrosternal airspace hypertransperancy of lungs |
| What is the sputum like in COPD | Clear, mucoid can become purulent with exacerbations of the COPD with pneumoniae, H. flu, moraxella catarrhalis |
| what would be your d/dx in CHF vs COPD | CHF will have fine basilar crackles on auscultation, CXR will show dilated heart and pulmonary edema, PFT will show volume restriction not airflow limitation |
| What is the ultimate goal in COPD TX and other goals | #1 disease prevention -relieve symptoms improve exercise tolerance improve health status prevent and treat complications prevent and treat exacerbations reduce mortality |
| What are the 4 components of managing COPD | assess and monitor disease reduce risk factors manage stable COPD manage exacerbations |
| What is involved in 1st component of managing COPD, Assess and monitor disease | assess with hx, physical and labs monitor progression, complications, co-morbidities, exacerbation hx |
| What is involved in 2nd component of managing COPD, Reduce risk factors | STOP SMOKING |
| What is involved in 3rd component of managing COPD, manage stable COPD | health education pharm treatment to prevent control symptoms, reduce frequency and severity of exacerbations, improve health, improve exercise tolerance |
| Can you use the stepdown approach for COPD like we do in asthma tx | no treatment needs to be maintained over long periods of time |
| Do the Meds used to tx COPD modify long term decline in lung function | no |
| What would be your treatment regimen for mild COPD | reduce risk factors, Flu vaccine, add SABA prn |
| What would be your treatment for moderate COPD | Add regular treatment with LABA ADD rehab to mild tx |
| What would be your treatment of severe COPD | ADD ICS to moderate and mild tx |
| What would be your treatment of very severe COPD | add long term O2 in addition to the mild, moderate, severe treatments |
| what are some surgical interventions for COPD | bullectomy, lung volume reduction surgery, lung transplant |
| What are the cardinal symptoms of an exacerbation of COPD | increased Dyspnea, increased sputum volume increased sputum purulence change in mentation |
| What is the most important aide in determining if someone is having an exacerbation of COPD | the most important thing is a good history of the patient |
| What test would you order for COPD exacerbation | spirometry pulse oximetry and ABGs CXR and EKG CBC- polycythemia, WBC count no helpful |
| What are some comorbid condition you need to rule out with COPD | pumonary emboli pneumonia CHG pneumothorax pleural effusion cardiac arrythmia |
| What will your treatment for COPD exacerbations be | empiric use of antibiotics increase dose and or frequency of SABA PO glucocorticosteroids |
Created by:
smaxsmith
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