CM- pulm -5- COPD
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| Is COPD curable | COPD is not curable but treatable and preventable
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| How would you characterize COPD | COPD is an airflow limitation that is not fully reversible and progressive associated with an abnormal inflammatory response
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| 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
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| What does chronic inflammation of lungs lead to | structural changes, narrowing of airways and destruction of lung parenchyma
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| What are the causes of death in patients with COPD | cardiovascular diseases
lung cancer
respiratory failure w/ advanced COPD
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| what percents of adults over 40 have airflow limitation | 1/4
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| What is a DALY | disability adjusted life year,
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| What is one of the problems with COPD in regards to epidemiology | underrecognition and underdiagnosis leads to significant underreporting
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| 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
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| 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
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| What airways can be effected in COPD | everyone proximal, peripheral airways, lung parenchyma and pulmonary vasculature
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| What can amplify lung inflammation in COPD | oxidative stress and excess proteases in the lung
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| What are the physiological changes in COPD | mucus, airflow limitation, air trapping, gas exchange abnormalities, cor pulmonale
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| What type of airflow disease is COPD obstructive or restrictive | obstructive
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| What systemic changes can you see in COPD | cachexia, skeletal muscle wasting, increased cardiovascular disease, anemia, osteoporosis, depression
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| In COPD will you have increase or decreased residual volume | increased residual volume
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| will you see increased or decreased total lung capacity in COPD | increased total lung capacity
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| Will you see hyper or hypo infaltion in COPD | hyperinflation
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| IF you get a patient to stop smoking will they regain normal lung function | NO but they will revert to a normal natural decline
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| 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)
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| What is the typical onset of COPD vs Asthma | COPD mid-life vs Asthma Early in life (childhood)
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| 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
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| What are the inflammatory cells seen in COPD vs Asthma | COPD- Neutrophils
Asthma- Eosinophils
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| What is the diffence in airway hyper-responsivness in COPD and Asthma | COPD- Absent
Asthma-present
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| What is the difference in regards to airflow limitation in COPD vs Asthma | largerly irreversible
largerly reversible
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| Looking for COPD what would you want to do during percussion of lungs | get a diaphragmatic excursion
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| What would you see on auscultation of COPD | reduced breath sounds maybe inspiratory wheezes or crackles
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| What would you need to get to help diagnose COPD | spirometry
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| What would you see in FEV1, FEV1/FVC ration, in COPD | Both would be reduced
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| What would see in a DLCO with COPD | reduced DLCO
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| 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%
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| What will you see in HCT lab of COPD patient | polycythemia hct >55%
1/4 patients actually have anemia
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| What would you see on a Chest X-ray with COPD | flat diaphragm
elongated heart
increased retrosternal airspace
hypertransperancy of lungs
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| What is the sputum like in COPD | Clear, mucoid can become purulent with exacerbations of the COPD with pneumoniae, H. flu, moraxella catarrhalis
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| 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
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| 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
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| What are the 4 components of managing COPD | assess and monitor disease
reduce risk factors
manage stable COPD
manage exacerbations
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| 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
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| What is involved in 2nd component of managing COPD, Reduce risk factors | STOP SMOKING
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| 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
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| 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
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| Do the Meds used to tx COPD modify long term decline in lung function | no
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| What would be your treatment regimen for mild COPD | reduce risk factors, Flu vaccine, add SABA prn
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| What would be your treatment for moderate COPD | Add regular treatment with LABA
ADD rehab to mild tx
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| What would be your treatment of severe COPD | ADD ICS to moderate and mild tx
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| What would be your treatment of very severe COPD | add long term O2 in addition to the mild, moderate, severe treatments
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| what are some surgical interventions for COPD | bullectomy, lung volume reduction surgery, lung transplant
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| What are the cardinal symptoms of an exacerbation of COPD | increased Dyspnea,
increased sputum volume
increased sputum purulence
change in mentation
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| 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
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| What test would you order for COPD exacerbation | spirometry
pulse oximetry and ABGs
CXR and EKG
CBC- polycythemia, WBC count no helpful
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| What are some comorbid condition you need to rule out with COPD | pumonary emboli
pneumonia
CHG
pneumothorax
pleural effusion
cardiac arrythmia
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| What will your treatment for COPD exacerbations be | empiric use of antibiotics
increase dose and or frequency of SABA
PO glucocorticosteroids
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