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Session 2 CM pulm5

CM- pulm -5- COPD

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