Np614 Chronic Cough, Chronic Dyspnea, And Copd

Front 1

How is COPD diagnosed?

Back 1

Chronic bronchitis is defined as a chronic cough with sputum production for at least 3 consecutive months, during at least 2 consecutive years, when other causes have been excluded.

Front 2

What is ephysema

Back 2

a progressive disease characterized by airflow limitations that are not fully reversible. Think of the lungs as balloons which simply do not totally deflate, so the person never gets a good deep breath.

Front 3

Prevelance of COPD

Back 3

•COPD is the 4th leading cause of death in the U.S. and causes serious, long-term disability

Front 4

Etiology of COPD

Back 4

•COPD: most often occurs in people age 40 and over with a history of smoking (either current or former smokers), although as many as 1 out of 6 people with COPD never smoked. Smoking is the most common cause of COPD-it accounts for as many as 9 out of 10 COPD-related deaths.
Environmental Exposure: COPD can also occur in people who have had long-term exposure to things that can irritate your lungs, like certain chemicals, dust, or fumes in the workplace. Heavy or long-term exposure to secondhand smoke or other air pollutants may also contribute to COPD.

Genetic Factors: In some people, COPD is caused by a genetic condition known as alpha-1 antitrypsin, or AAT, deficiency (alpha1-antitrypsin is a protease inhibitor produced by the liver that acts in the lungs). While very few people know they have AAT deficiency, it is estimated that close to 100,000 Americans have it. People with AAT deficiency can get COPD even if they have never smoked or had long-term exposure to harmful pollutants.

Front 5

What are s/s of COPD?

Back 5

•Constant coughing, sometimes called "smoker's cough"
•Shortness of air while doing activities the patient used to be able to do
•Excess sputum production
•Feeling like they can't breathe
•Not being able to take a deep breath
•Wheezing
•Changing what they do because they cannot catch their breath; this may actually be the most important of all the signs (in my opinion). When COPD is severe, shortness of air and other symptoms can get in the way of doing even the most basic tasks, such as doing light housework, taking a walk, even bathing and getting dressed.

Front 6

How to diagnose COPD

Back 6

Spirometry: •Determines severity
•Distinguishes from asthma
FEV1/FVC < 0.7 - need to stop smoking
Chest xray changes
Chronic cough, dyspnea worsens over time, worsens iwth exercise, persistent, chronic sputum [production, hx of smoke

Front 7

What is 5 step method for CXR interpertation

Back 7

1: assess lung for full expansion 2: assess pleura - see if comes all way down to diaprham (do you see the diaphramatic arch - this means lungs expanded or flat area), is it dark, costo 3: Look for inflitrates 4: look at the mediastinum 5: Assess the abdomen

Front 8

Lung tissue should not be visible below 7th anterior rib

Back 8

true if seen lower then has COPD. lungs look darker than normal, diaphram flat, barrell shaped chest

Front 9

How to treat COPD pharmacologically

Back 9

prophylactic antibiotic therapy, mucolytics, vasodilators, nedocromil and leukotriene modifiers, and antioxidants. 15 hours or more of oxygen daily, bronchodilators & inhaled corticosteriods

Front 10

What see on a physical assessment of COPD

Back 10

•Hyperinflated chest
•Purse lip breathing
•Use of accessory muscle
•Paradoxical movements of lower ribs
•Reduced crico-sternal distance
•Reduced cardiac dullness
•Wheeze or quiet breath sounds

Front 11

How is spirometery helpful with COPD

Back 11

Spirometry is useful for the definitive diagnosis of COPD and for the staging of disease severity, and should be performed in individuals with symptoms suggestive of COPD.

Front 12

Know these meds for COPD

Back 12

•inhaled corticosteroids
•anticholinergics
•beta-adrenergic 2 agonists
•Spriva HandiHaler (tiotropium)
•theophylline
•oral coriticosteroids when would you use these?
•guiafenesin
Home O2 houres a day needs & what dose, What drugs shoudl pt avoid

Front 13

What are inhalers used for COPD

Back 13

Short-acting B2 Agonists
Albuterol
90-180, 200 DPI, HFA
Q4-6 h
Short-acting anticholinergics
Atrovent
20-40 MDI, HFA
Q 4-6 h
Long-acting B2-agonists
Servent
Long-acting anticholinergics
Spriva
18 DPI
Q 24 h
Inhaled corticosteroids
Pulmicort 100, 200 DPI q12 hours
Combination therapy
Symbiotic q 12 hours
Foradil

Brovana

Front 14

What inhaler is mostly used for COPD and not for Asthma?

Back 14

Long-acting anticholinergics
powdered inhaler - hold breath for 10 sec and then exhale and rinse mouth afterwards, not a rescue inhaler will not help with an attack. Spriva better as only need once a day, inhaled Steriods use not as useful in COPD as in astham

Front 15

Oxygen in COPD

Back 15

pul ox <88%, cont use, acute dyspnea, or exercise. Reserved for severe COPD

Front 16

WHat are non-phamacologic formulations used for COPD

Back 16

smoking cessation, Chantix or Wellbutrin,n physical exercise - walkiing and stair climbing, s/s better with exercise

Front 17

How does COPD begin?

Back 17

airtrapping or hyperinflation has SOA early s/s, then experience exercise intolerance & restrict physical activity, then has physical deconditioing then can cause disability

Front 18

What other aspects need to be addressed with COPD?

Back 18

•Exercise
•Breathing techniques
•Lifestyle modifications
•Social ramifications
•Marital/relationship issues
•Dietary issues

Front 19

What is interstitial Lung disease?

Back 19

Restrictive lung diseases are characterized by fibrosis in the lungs’ alveoli and small airways. Alveolar walls thicken, portions of the pulmonary capillary bed are destroyed, and increased elastic connective tissue holds small airways open. While exhalation is rapid with increased FEV1 (the opposite of obstructive disorders), it is difficult for these patients to inhale effectively. They will have low total lung capacity (TLC) with a fall in vital capacity (VC).

Front 20

What causes interstitial lung disease or restrictive lung disease?

Back 20

idiopathic pulmonary fibrosis, sarcoidosis, histiocytosis, pulmonary manifestations of systemic rheumatic disorders (RA, SLE, scleroderma, ankylosing spondylitis, etc.), fibrosis induced by a number of drugs, and several other inherited disorders. Also caused by occupational exposures, inhaled dust ike asbestosis, coal works or black lung and silicosis from sand and rock dust.

Front 21

What are s/s of institial lung disease?

Back 21

breathlessness with exercise. dry cough. Diagnosis hard - careful hx important ask about environmental or occupational hazards, hobbies, legala nd illegal drug use, arthritis,

Front 22

What kinds of pt are seen with sleep apnea

Back 22

•Overweight patients with a body mass index (BMI) >25
•Patients with excess adipose tissue in the neck (Neck circumference >16 [women], >17 [men])
•Patients with a history of snoring or excessive daytime sleepiness
•Patients with erectile dysfunction of undetermined etiology
•Patients with hypertension
•Patients with congestive heart failure (CHF)
•Patients with arrhythmias
•Patients with cerebral vascular disorders (transient ischemic attack [TIA], Stroke, Dementia)
Other factors: smokers, hypothryoidism, risk for CVD, fam hx, post-menopausal women, pt c/o of fatigue

Front 23

What kinds of c/o do you see with someone who might have sleep apnea?

Back 23

•Complaints of frequent nocturnal awakenings
•Complaints of difficulty concentrating
•Complaints of problems with memory
•Complaints of snoring and/or apnea by patient or significant other
•Complaints of daytime sleepiness or fatigue
•Complaints of depression

Front 24

What are risk factor for sleep apnea?

Back 24

obesity til 50 (don't have to be obese to have sleep apnea), male gender until about 50, postmenopausal women, upper airway antomic abstruction, balck, asian, hispanic, being a football player (d/t neck size)

Front 25

Waht can see iwth someone iwth sleep apnea?

Back 25

cognitive impairment, motor vehicle accidents, impaired quality of life, sysptemic hypertension (drug resistant), pulmonary hypertension, nocturnal arrhythmias, CAD, TIA/Stroke, insulin resistence

Front 26

What someone will c/o when have sleep apnea

Back 26

snoring, unfreshing sleep, daytime sleepiness, witnessed apneas, insomnia, restless sleep, morning HA, nocturia, dry mouht, sore throat, nasa/sinus congestion, fam hx, mood, memory and learning problems

Front 27

What conditions are associated with sleep apnea?

Back 27

large tonsils & uvula, deviated septums, small chins,

Front 28

How is diagnosis done for sleep apnea

Back 28

sleep study, meausre ECG, ox Sat, airflow (end title co2)

Front 29

How are inhaled corticosteriods used in COPD?

Back 29

Not used - mostly in asthma as COPD is not an inflammatory disease

Front 30

How to leukotriene modifiers work?

Back 30

Supress leukotrienes, compoudns tha promote bornchoconstrucions as well as mucus production and airway edema

Front 31

How do bronchodilators Beta2 agonists work?

Back 31

they promote bronchodilation only for symptomatic relief

Front 32

How does theophylline work

Back 32

bronchodilation, narrow theraputic range, careful dosage administration

Front 33

How do anticholinergic agents work?

Back 33

block muscarinic receptors in bronchi causing brochi dilation.Used only for maintenance therapy only. Wll not relieve rapdi bronchospasm. Tiotropium longer acting than ipratropium

Front 34

Most common presenting s/s with COPD

Back 34

dyspnea with exertion, ask smoking hx,, ppd, years smoke, success with stopping, ask about cough, sputumn, resp tract infections

Front 35

Physical exam with COPD

Back 35

diagnose with spirometry. late stages see clubbing of fingernails, increase of anteroposterior diameter and increaes in intoercostal spaces.,
diminished movement of rib cage with inspiration, forward sitting posture, pursed lip breathing with prolonged expirations, increased resonance with percussion, diminshed breath sounds, can see right ventricle hypertrophy

Front 36

Diagnosis of COPD

Back 36

FEV in 1 second, chest xray flatteing of diaphram, blunting of costophrenic angles, pulse ox & bld gases, CBC to measure H&H to measure hypoxemia

Front 37

How to manage COPD

Back 37

stop smoking, exercise, oxygen therapy, control cough and secretions, o2 therapy for under 88% or if under 89% and hct 55%, first choice pharmcologic: inhaled anticholinergic with resuce beta agonist inhaler - bronchodilation. Also come in combo therapy

Front 38

When use oral corticosteriods in COPD?

Back 38

with acute exacerbations

Front 39

Describe non pharmacologic therapies for COPD

Back 39

pulmonary rehab, execise training, immunizaiton against flu and pneumonia, nutritional help eat frequent small meals with vit supplimentation

Front 40

Complication of COPD

Back 40

cor pulmonale - righ tsided heart failure

Front 41

When see OSA (Obstructive sleep apnea)?

Back 41

2-4% of women and 4-10% of men. caused by repetitive upper airway narrowing of closure which occurs during sleep ileading ot inc efforts to breath, ending w/ brief CNS arousal to reestabish patency of upper airway. Occur many times per night, leading to sleep fragmentation and poor-quality sleep.

Front 42

Clinical presentation of OSA (obstructive sleep apnea)?

Back 42

loud snoring with or without witnessed apneas, nocturnal gasping or chocking. c/o daytime drowsiness, fatigue, tiredness

Front 43

What can untreated OSA cause?

Back 43

hypertension

Front 44

How is OSA treated

Back 44

with nasal contiuous positive airway pressure CPAP machiene. Need to have personal fit and often hard to get used to

Front 45

What medications can exacerbate OSA (obstructive sleep apnea)?

Back 45

alcohol, opiates, muscle relaxants.

Front 46

How to distinguish between Mild to very severe COPD

Back 46

mild FEV1>80% - mild airflow obstruction pt usually unaware of problem, Moderate: FEV1 < 80% predicted - SOA with exertion, cough & sputum most seek medical care now, Severe: FEV1 < 50% predicted - greater SOA, reduced exercise capacity, impacts quality of life, Very Severe: FEV1 < 30% predicted, resp failure and cor pulmonale, elevation of jugular venous distention, pitting ankle edema,

Front 47

What important part of routine office visit for COPD

Back 47

demonstration use of MDI

Front 48

When can home O2 be ordered?

Back 48

85% or less on room air

Front 49

How can exacerbations be decreased with COPD

Back 49

immunization against influenza and pneumonia

Front 50

What is treatment of choice for pneumonia with green sputum

Back 50

z-pack

Front 51

How should steriods be used in COPD

Back 51

only with COPD exacerbation, but nto short bursts, but tapered

Front 52

What are risk factors for COPD

Back 52

smoking, occupational dusta dn chemicals, indoor smoke from cooking (developing countries),

Front 53

What can cause exacerbations of COPD?

Back 53

infection or air pollution, and some cannot be identified as to a reason

Front 54

WHat does FVC measure?

Back 54

the amount of air that can be expelled until no more air can be expeled and must be at least 6 seconds and can take up to 15 seconds or more how quickly the lungs can be emptied. FEV1 is amount of air that can be expelled in 1 second