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47 Cards in this Set
- Front
- Back
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Where does COPD rank in causes of death in the US?
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4th
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Types of Causes of Airflow Obstruction?
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Luminal Causes
Mural Causes Extramural Causes |
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Types of Luminal Causes?
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Mucus Plug
Tumor Foreign Body |
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Types of Mural Causes
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Bronchial Wall Edema
Infl Cell Infiltration Mucus Gland Hypertrophy Acute Bronchoconstriction Smooth Muscle Hypertrophy Airway Wall Remodeling (fibrosis) |
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Types of Extramural Causes?
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Loss of Alveolar Attachments
Decreased Lung Elastic Recoil (think emphysema) |
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Decline in FEV1
Normal vs COPD vs Accelerate COPD |
Normal: 25-30mL per year after 25
COPD: 45-60mL/yr Accelerated (20% of smokers): 150-200mL/yr |
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COPD vs Asthma
reversibility? |
COPD: partially w/ cessation and bronchodilator
Asthma: near normal w/ bronchodilators |
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COPD vs Asthma
when do they cough? |
COPD: early AM
Asthma: Nocturnal, post exercise |
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COPD vs Asthma
elevated IgE? |
COPD: rare
Astham: common |
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Sx's that accompany an AE?
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Inc Cough
Inc Sputum Fever Dyspnea Wheezing Dec FEV1 |
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Frequency of AE's in COPD pts?
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1 or 2 per year
often precipitated by infection |
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How to reduce frequency of AE's?
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Maximize FEV1
Long-term bronchodilator use Vaccinations |
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Why are AE's so important?
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Major determinant of QOL
Consume 70% of $$ spent on COPD Accelerate loss of fxn and FEV1 Predictor of mortality |
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COPD findings on Physical Exam?
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Hyperresonance on percussion
Dec breath sounds Wheezing or prolonged exp phase Thin w/ muscle wasting Barrel chest Pursed lip breathing Peripheral Edema |
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CXR findings in COPD pts?
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Often normal till late
Flat Diaphragms Hyperexpanded lung fields Inc Radiolucency Bullae Long, Narrow Heart |
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Spirometry Findings required for COPD Dx?
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FEV1 < 80% predicted
FEV1: FVC <70% predicted |
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What constitutes a positive bronchodilator response?
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12% AND 0.2 L increase in either FEV1 or FVC
COPD pts often have this |
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ABG's typicall worsen in COPD pts w/????
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Exercise
Sleep AE's |
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Components of BODE Index for COPD Staging?
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BMI
Airway Obstruction (FEV1) Dyspnea (scaled) Exercise Capacity (6 minute walk in meters) |
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Types of Rx for COPD
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Smoking Cessation
Pharmacotherapy O2 Therapy Pulmonary Rehab Transplant |
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Which Rx will improve FEV1?
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only Inhaled Bronchodilators
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Types of Pharmacologic interventions for smoking?
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Antidepressants (bupropion)
Nicotine Replacement Therapy Nicotine Receptor Agonist (chantix) |
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How to prescribe bupropion for smoking?
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Start it 1-2 weeks before quit date
Continue for 7-12 weeks |
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Two types of bronchodilators?
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Short Acting
Long Acting |
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Examples of Short Acting Bronchodilators?
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Anticholinergic (ipratropium bromide)
Beta Agonist (albuterol) |
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Types of Long Acting Bronchodilators?
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Anticholinergic (tiotropium)
Beta Agonist (salmterol) |
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Which type of bronchodilator is best for COPD?
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Anticholinergics!
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Benefits of Anticholinergics in COPD?
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Inc FEV1
Reduced AE's Minimal SE's (don't cross BBB, minimal GI distress) |
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When should you prescribe a Beta Agonist?
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If initial anticholinergic therapy is suboptimal
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SE's of beta agonist?
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Tachycardia
Arrhythmias Jitters |
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How often do you have to use the long acting inhalers?
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Anticholinergic: once a day
Beta Agonist: twice a day Ok to use w/ short acting inhalers |
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Who gets Inhaled corticosteroids?
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Pts w/ wheezing and/or frequent AE's
Along w/ long acting bronchodilators |
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Benefits of Inhaled Corticosteroids?
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Dec AE's
Inc QOL controversial |
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Why are Corticosteroids not beneficial?
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Don't change decline of FEV1
Don't change mortality rate SE: bone loss, catarracts, pneumonia |
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Other possible drug used for COPD?
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Theophylline
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Pro's for Theophylline?
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Oral Agent
Long Acting Bronchodilator + Antiinflammatory Improves FEV1 and gas exchange Improves Resp Muscle Fxn |
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Con's for Theophylline?
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Narrow therapeutic window
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Who wins, pros or cons?
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Cons
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When are systemic corticosteroids used for COPD?
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During AE's for 1-2 weeks
Not good long term b/c of SE's |
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Flow of Rx for AE's?
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Empiric Antibiotics
Oral Corticosteroids Nebulized Bronchodilators O2 Therapy Hospitalization Mechanical Ventilation |
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Does supplemental O2 increase survival COPD pts?
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YES YES YES
dec Pulm HTN dec risk of arrhythmias |
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Who gets long term O2 therapy?
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PaO2 <55mmHg
or SaO2 <88% |
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Benefits of long term O2 therapy?
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Inc survival of hypoxemic pts
Inc cognitive fxn Inc Exercise performance Inc sleep quality inc Activities of Daily Living |
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Benefits of Pulmonary Rehab?
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Reduced Dyspnea
Inc Exercise capacity Inc QOL Dec AE's Dec Hospitalizations and mortality |
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What does Pulm Rehab not do?
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Doesn't Improve PFT's or ABG's
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Who is eligible for a lung transplant?
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Not smoking for 6 months
Advanced disease (FEV1<25%) Age < 65 and able to rehab No Severe Comorbidities |
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Benefits of Transplant?
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Inc FEV1
Inc QOL Extends Life |
