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39 Cards in this Set
- Front
- Back
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******* COPD ************
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******* COPD ************
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Pathophysiology of COPD
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Slowly progressive inflammatory disease of the airways and lung parenchyma.
It is characterized by gradual loss of lung function with increasing obstruction to EXPIRATORY airflow. |
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What is the effective dose of IV steroids in severe COPD exacerbation?
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The effective dose is not known
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Test to diagnose COPD
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post bronchodilator FEV1/FVC ratio < 70 is diagnostic.
Note, diagnostic spirometry should be performed AFTER administration of inhaled bronchodilators because this will improve the accuracy of the study results. |
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When to use antibiotic's and COPD
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1. In treating infectious exacerbations of COPD.
2. In patients with severe exacerbations of COPD who require mechanical ventilation, whether invasive or noninvasive. A quinolone or third–generation cephalosporin is usually a good choice to cover pulmonary pathogens. |
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Percentage of heavy smokers who develop COPD
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20%
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Initiation of treatment for COPD
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1. Initiate monotherapy with LABA or long–acting anticholinergic (tiotropium) in patients with FEV1 < 60% of predicted.
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Recommendation for oxygen at home
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1. Resting hypoxemia with PaO2 of 55 or lower
2. Resting pulse ox of 88% or lower |
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COPD Risk factors?
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Smoking
TB Asthma Poor education / SE status air pollution occupational exposure |
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Large global risk factor for COPD other than smoking
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Exposure to smoke from indoor burning biomass fuels such as wood, charcoal, and vegetable matter.
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Pulmonary rehab in COPD?
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- Use for FEV1 < 50%
- Avoid in smokers, ppl unable to walk, co–morbidities, severe dyspnea - Improves sx and reduces hospitalizations |
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What is lung volume reduction surgery?Criteria?
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Involves resecting up to 30% of disease or nonfunctioning parenchyma to reduce hyperinflation and allow the remaining lung to function more efficiently.
For FEV1 20-45%, TLC > 100%, RV > 150%, completed pulm rehab, DLCO > 20% |
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Pulmonary complications of COPD
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Pulmonary hypertension
Cor pulmonale Pneumonia Pneumothorax Bronchiectasis Atelectasis Lung cancer |
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Roflumilast? |
- PDE4 inh For severe COPD FEV1 < 50% - improves sx and FEV1 - not for acute use or in pt with liver failure - AE: diarrhea, weight loss, psych sx |
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PPI in COPD? |
May prevent exacerbations in older pts |
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Hospital d/c for COPD exacerbation? |
SABA > q4hrs stable ABG 12-24h f/u 2-4 weeks able to understand correct use of meds |
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COPD and airline flights? |
If PaO2 < 70, do hypoxia altitude sim test PaO2 < 50 => need O2 PaO2 > 55 => OK else borderline |
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medication to decreae freq of COPD exacerbations |
abx for 5 days q 8wks (azithro or moxi) |
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Young man, bullous emphysema, what test to do? |
serum alpha 1 antitrypsin - also check in COPD dx before 45 and in nonsmokers |
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= DIFFUSE PARENCHYMAL LUNG DISEASE = |
= DIFFUSE PARENCHYMAL LUNG DISEASE = |
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Diffuse Parenchymal dz, time course |
Usually > 3 months. If longer, consider infectious and cardiogenic |
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Best test for evaluating diffuse parenchymal lung disease?
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High resolution chest CT
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Idiopathic pulmonary fibrosis:
dx, px, tx |
- most common idiopathic interstitial disease.
CT findings: peripheral and basal prominent groundglass, honeycomb and reticular changes. Prognosis, is poor with median survival 3 to 5 years. tx: - NO Steroids - Pulm rehab / O2 if < 89% improve sx - Lung transplant improves survival |
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Peak expiratory flow rate (PEFR) in acute asthma exacerbation
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Moderate exacerbation: PEFR 40–69% of predicted personal best
Severe exacerbation: PEFR <40% |
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Characteristics of nonspecific interstitial pneumonia
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Most often associated with underlying connective tissue disease.
Diagnosis: 1. Chest CT showing groundglass without honeycombing 2. requires open lung biopsy showing lymphoplasmacytic interstitial infiltration Treatment: responds to steroids |
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What is cryptogenic organizing pneumonia?
Presentation? CXR? dx? tx? |
COP is the idiopathic form of bronchiolitis obliterans organizing pneumonia (Boop).
Presentation: initially cough and shortness of breath suggestive of CAP. But is thought about after the first 6 to 8 weeks of treatment with abx but patient not improving. CXR: bilateral, diffuse opacities Diagnosis: lung biopsy confirmed dx Treatment: good response to systemic steroids |
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Common connective tissue diseases that cause interstitial lung disease?
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1. Systemic sclerosis: diffuse parenchymal lung disease is the leading cause of mortality
2. Rheumatoid arthritis |
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What is hypersensitivity pneumonitis?
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Pneumonitis caused by repeat inhalation of finely dispersed antigens; Such as mold, bird feathers and droppings, laboratory animal dander and so on.
Treatment: 1. Antigen avoidance 2. Oral steroids for patients with severe symptoms |
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Types of drugs that cause parenchymal lung disease
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1. Amiodarone: Clearence of drug from pulmonary parenchyma is very slow.
2. MTX; Less than 5% of patients treated with this drug developed diffuse pulmonary infiltrates. 3. Nitrofurantoin; Kerley B lines seen on chest x–ray 4. rituximab |
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Radiation pneumonitis
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Present with cough and/or dyspnea 6 weeks after exposure.
Most parenchymal changes resolve after six months. Treatment: steroids in some cases |
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Sarcoidosis lung manifestation
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Sarcoidosis is a multi organ inflammatory disease characterized by tissue infiltration by:
–Noncaseating granulomad –Mononuclear phagocytes –Lymphocytes 90% of patients with sarcoidosis will have pulmonary involvement. CXR/CT: hilar lymphadenopathy (Lofgren syndrome) |
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Sarcoidosis i. who requires tissue biopsy? ii. how to biopsy |
i. Biopsy everyone except: Loeffler Syndrome (erythema nodosum, fever, arthralgia, and hilar lymphadenopathy) Heerfordt syndrome (uveitis, parotid gland enlargement, and fever) ii. Bronch + EBUS |
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What is Lymphogioleiomyomatosis (LAM)?
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- rare cystic lung disease seen in young women of childbearing age or in association with tuberous sclerosis.
Consider this dx when spontaneous pneumothorax +/- chylothorax in a young woman with chest imaging demonstrating hyperinflation and chest CT showing diffuse, thin–walled, small cyst. |
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Bronchial thermoplasty
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Indicated in severe cases/difficult to manage asthma.
It consist of applying heat to the airway with a catheter that is inserted via bronchoscope connected to radio frequency generator. This treatment should occur three times. It is supposed to reduce smooth muscle hypertrophy which has been reported in patients with asthma. |
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Classification of the Diffuse Parenchymal Lung Diseases? |
Known Causes: CTD, hypersensitivity (bird hot tub), occupational, drug-induced, radiation, acute eos PNA Unknown: Sarcoid, IPF, COP, LAM, chronic Eos PNA |
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Acute Interstitial Pneumonia? |
- characterized by rapid onset of disease over days to weeks that results in progressive respiratory failure - corticosteroids, supportive care in the ICU with low tidal volume ventilation |
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Psittacosis i. caught from ii. organism iii. how diagnosed |
i. pet birds
ii. Chlamydia psittaci iii. complement fixation and serology |
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Pt from developing county. Eosinophilia, cough and wheeze despite B2. b/l infiltrate, ANCA neg. Consider... tx? |
Loeffler's syndrome from Strongyloides Give Thiabendazole |
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ABPA, hypersens pneumonitis, Allergic Angitis (Churg-strauss) Which have Eosinophils? |
ABPA, Churg-strauss |
