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20 Cards in this Set
- Front
- Back
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who is at risk for COPD?
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80-90% of COPD is due to cigarette smoking. Other RF include 2nd hand smoke, genetic (alpha 1 antitrypsin deficiency)
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what is COPD?
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It is a treatable, preventable and partially reversible disease characterized by progressive airflow.
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When should clinician consider dx of COPD?
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History of significant tobacco smoking, cough, sputum production, dyspnea, decrease exercise tolerance.
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What is the role of PFT (spirometry)?
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Spirometry is needed for dx and classification of COPD. Generally; post bronchodilator FEV1/FVC < 70% is the dx threshold for COPD.
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What is the BODE index?
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B: BMI >21, O: obstruction, D: Dyspnea, E: exercise; distance walked in 6 min >350 ft is goal. Increasing index is associated with higher risk for hospitalization.
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What other laboratory test should you order when you evaluating for COPD?
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CXR, CT, Alpha 1 antitrypsin levels. Exercise testing may be also be useful.
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What are some drugs for COPD?
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first STOP smoking then
A: anticholinergic (tiotropium) B: Beta agonist C: corticosteroid (inhaled) D: eDucation |
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What are some of the differences between asthma vs COPD?
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In general
Asthma: usually younger, non-smoker, intermittent sx COPD: older, chronic productive cough, persistent dyspnea |
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What is the role of LABD (long acting beta dilator)?
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For patient with stable COPD whose FEV1 <60% along with inhaled corticosteroids. (ACP recommendation)
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What is the role of brochodilators in COPD?
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no data to recommend one vs another. Short acting bronchodilator for mild and for rescue tx. Monotherapy with LABD reduce frequency of exacerbation but not hospitalization nor mortality.
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What to do if monotherapy is insufficient?
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Combo with LABD and anticholinergic is significant better in alleviating dyspnea.
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When should corticosteroid be considered?
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Adding inhaled corticosteroid for moderate to severe COPD with FEV1 of <50% of predicted.
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What is the role of oral corticosteroid?
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It should be limited to tx COPD exacerbation.
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When to add oral theophylline to inhaled drug therapy?
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It can be used in pt with refractory sx despite inhaled bronchodilator and corticosteroids.
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How should you manage acute COPD exacerbations?
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depends on severity, in general, prompt recognition, adjust bronchodilator and steroid tx, initiate antibiotics and assess the need for hospitalization.
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What are the most common bacterial pathogen in COPD?
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H: Hemophilus influenza
S: streptococcus pneumoniae M: Moraxella catarrhalis. |
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How long should one be on oral steroid for COPD exacerbation?
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There is good evidence that 6 wk is not better than 2 weeks.
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When should O2 therapy be instituted?
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Criteria of long term O2 therapy include: PaO2 <55 on RA, or SaO2 <88%, Noctural hypoxemia SaO2 <88%, Exercise hypoxemia SaO2 <88%.
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When should considered surgical therapies?
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1. e/o bilat emphysema
2. post dilator TLC>150% RV 100% 3. Max FEV1 <45% |
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When is lung transplantation be considered in COPD?
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When BODE >7
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