Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
81 Cards in this Set
- Front
- Back
|
COPD is characterized by...
|
is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases.
|
|
|
In COPD, ________________and _________________contribute to the overall severity in each individual patient
|
In COPD, exacerbations and comorbidities contribute to the overall severity in each individual patient
|
|
|
__________________ is the primary cause of COPD.
|
Cigarette smoking is the primary cause of COPD.
|
|
|
COPD is the __________ leading cause of death in the United States.
|
COPD is the 4th leading cause of death in the United States (behind heart disease, cancer, and cerebrovascular disease).
|
|
|
True or false: In 1990, COPD was ranked 12th as a burden of disease; by 2020 it is projected to rank 5th.
|
true
|
|
|
Risk factors for COPD
|
Lung growth and development
Gender Age Respiratory infections Socioeconomic status Asthma/Bronchial (hyperreactivity) Chronic Bronchitis Genes Exposure to particles Tobacco smoke Occupational dusts, organic and inorganic Indoor air pollution from heating and cooking with biomass in poorly ventilated dwellings Outdoor air pollution |
|
|
COPD can be caused by a deficiency of ____________________.
|
COPD can be caused by a deficiency of alpha-1 antitrypsin
|
|
|
Inflammation is the root of _______________ disease and _______________________destruction.... Which both lead to ________________________.
|
Inflammation is the root of Small air way disease and parenchymal destruction.... Which both lead to air flow limitation.
|
|
|
small air way disease refers to
|
airway inflammation and airway remodeling
|
|
|
parenchymal destruction refers to
|
Loss of alveolar detachments and decrease of elastic recoil
|
|
|
Asthma inflammation involves which cells? Is air flow limitation this reversible?
|
sensitizing agent
CD4, t-lymphocytes, eosinophils... this is completely reversible |
|
|
COPD inflammation involves which cells? Is this air flow limitation reversible?
|
noxious agent
CD8, t-lymphocytes, macrophages, neutrophils not reversible |
|
|
Patho of COPD
|
Chronic inflammation
Airway narrowing & hyperactivity Alveolar attachment destruction Mucus hypersecretion Bacterial colonization Ciliary destruction |
|
|
COPD onset normal occurs ____________.
Symptoms progress ___________. Also often occurs with a long hx of _____________. |
Onset in mid-life
Symptoms slowly progressive Long smoking history |
|
|
Asthma onset normal occurs ____________.
Symptoms progress ___________. Also often occurs with _____________. |
Onset early in life (often childhood)
Symptoms worse at night/early morning Family history of asthma |
|
|
Asthma is often accompanied by:
|
Allergy, rhinitis, and/or eczema
|
|
|
Diagnosis of COPD is based on:
But ultimately diagnosed by: |
Symptoms and risk factors
Spirometry: Diagnosis based on a post-bronchodialator FEV1/FVC < 0.7 |
|
|
Goal of COPD assessment are:
|
The goals are to determine the:
-severity of the disease -severity of airflow limitation -the impact on the patient’s health status -the risk of future events. Also, Comorbidities occur frequently and should be actively looked for and treated appropriately if present |
|
|
The characteristic symptoms of COPD are:
|
The characteristic symptoms of COPD are chronic and progressive dyspnea, cough, and sputum production.
-Dyspnea: Progressive, persistent and characteristically worse with exercise -Chronic cough: May be intermittent and may be unproductive -Chronic sputum production: COPD patients commonly cough up sputum |
|
|
The diagnosis and staging of COPD require what two spirometric measures?
|
What are FEV1/FVC and FEV1
|
|
|
The CAT is:
|
COPD Assessment Test (CAT): An 8-item measure of health status impairment in COPD (http://catestonline.org).
|
|
|
The mMRC is:
|
Breathlessness Measurement using the Modified British Medical Research Council (mMRC) Questionnaire: relates well to other measures of health status and predicts future mortality risk.
|
|
|
Classification of Severity of Airflow Limitation in COPD
|
In patients with FEV1/FVC < 0.70
GOLD 1 GOLD 2 GOLD 3 GOLD 4 |
|
|
GOLD 4
|
GOLD 4: Very Severe FEV1 < 30% predicted
|
|
|
GOLD 3
|
GOLD 3: Severe 30% < FEV1 < 50% predicted
|
|
|
GOLD 2
|
GOLD 2: Moderate 50% < FEV1 < 80% predicted
|
|
|
GOLD 1
|
GOLD 1: Mild FEV1 > 80% predicted
|
|
|
When assessing risk, choose the ________________risk according to _________________ or _______________________.
|
When assessing risk, choose the highest risk according to GOLD grade or exacerbation history
|
|
|
FEV1 means...
|
Forced expiratory volume in one second
(so you want to get out at least 70% of your forced vital capcity (FVC) in one second) |
|
|
COPD pts are at risk for these comorbidities:
|
Cardiovascular diseases
Osteoporosis Respiratory infections Anxiety and Depression Diabetes Lung cancer |
|
|
Additional clinical investigations of COPD
|
-Chest X-ray:
-Lung Volumes and Diffusing Capacity -Oximetry and Arterial Blood Gases -Alpha-1 Antitrypsin Deficiency Screening -Exercise Testing -Composite Scores |
|
|
Composite Scores
|
Composite Scores: Several variables (FEV1, exercise tolerance assessed by walking distance or peak oxygen consumption, weight loss and reduction in the arterial oxygen tension) identify patients at increased risk for mortality.
|
|
|
Exercise testing
|
Self paced walking (such as the 6 min walking test) or during incremental exercise testing in a laboratory, is a powerful indicator of health status impairment and predictor of prognosis.
|
|
|
Alpha-1 Antitrypsin Deficiency Screening
|
Alpha-1 Antitrypsin Deficiency Screening: Perform when COPD develops in patients of Caucasian descent under 45 years or with a strong family history of COPD.
|
|
|
Oximetry and Arterial Blood Gases
|
Oximetry and Arterial Blood Gases: Pulse oximetry can be used to evaluate a patient’s oxygen saturation and need for supplemental oxygen therapy.
|
|
|
Chest X-Ray
|
Seldom diagnostic but valuable to exclude alternative diagnoses and establish presence of significant comorbidities.
|
|
|
Lung Volumes and Diffusing Capacity
|
Lung Volumes and Diffusing Capacity: Help to characterize severity, but not essential to patient management.
|
|
|
Goals of management
|
Prevent acute exacerbations
Relieve symptoms Slow progression of deteriorating lung function Reduce mortality Improve quality of life |
|
|
_______________________ has the greatest capacity to influence the natural history of COPD. What can practitioners do?
|
Smoking cessation has the greatest capacity to influence the natural history of COPD. Pharmacotherapy and nicotine replacement reliably increase long-term smoking abstinence rates.
|
|
|
All COPD patients benefit from ______________________and should repeatedly be encouraged to_______________________.
|
All COPD patients benefit from regular physical activity and should repeatedly be encouraged to remain active.
|
|
|
Appropriate pharmacologic therapy can: (3 things)
|
Appropriate pharmacologic therapy can:
-reduce COPD symptoms -reduce the frequency and severity of exacerbations -Improve health status and exercise tolerance. |
|
|
True or False: None of the existing medications for COPD has been shown conclusively to modify the long-term decline in lung function.
|
True: None of the existing medications for COPD has been shown conclusively to modify the long-term decline in lung function.
|
|
|
When should COPD patients get the PNA vaccine?
|
Age doesn't matter. Booster every 5 years.
|
|
|
What interventions reliably increases long-term smoking abstinence rates and are significantly more effective than placebo.
|
Nicotine replacement therapy as well as pharmacotherapy with varenicline, bupropion, and nortriptyline
|
|
|
True or false: A brief (3-minute) period of counseling to urge a smoker to quit really doesn't have much impact on smoking cessation.
|
False: A brief (3-minute) period of counseling to urge a smoker to quit results in smoking quit rates of 5-10%... This is significant
|
|
|
Brief Strategies To Help The Patient Willing To Quit Smoking
|
ASK: Systematically identify all tobacco users at every visit.
ADVISE: Strongly urge all tobacco users to quit. ASSESS: Determine willingness to make a quit attempt. ASSIST: Aid the patient in quitting. ARRANGE: Schedule follow-up contact. |
|
|
Fletcher Curve
|
Shows that once you quit smoking, your FEV1 curve will parallels the curve of a non smoker. So quitting at anytime is beneficial... but the sooner, the better.
|
|
|
Therapy at the mild stage includes
|
Reduction of risk factors: Influenza vaccination
Short-acting bronchodilator |
|
|
Therapy at the moderate stage includes
|
Reduction of risk factors: Influenza vaccination
Short-acting bronchodilator Long acting bronchodilator: pulmonary rehab |
|
|
Therapy at the severe stage includes
|
Reduction of risk factors: Influenza vaccination
Short-acting bronchodilator Long acting bronchodilator: pulmonary rehab Add ICS if repeated exacerbations |
|
|
Therapy at the very severe stage includes
|
Reduction of risk factors: Influenza vaccination
Short-acting bronchodilator Long acting bronchodilator: pulmonary rehab Add ICS if repeated exacerbations O2 Surgery (not routinely done anymore) |
|
|
Bronchodilator medications are central to ________________________________________
|
Bronchodilator medications are central to symptom management in COPD.
|
|
|
Bronchodilator choices:
|
The choices between beta2-agonist, anticholinergic, theophylline, or combination therapy depends on availability and individual response in terms of symptom relief and side effects.
|
|
|
Beta 2 agonists MOA
|
Principal action is airway relaxation by stimulating Beta 2 adrenergic receptors which increases cyclic AMP and causes bronchodilation
|
|
|
Duration of short aging beta agonists verses long acting
|
short acting Beta 2 agonists: 4-6 hours
Long acting Beta 2 agonists (Formoterol and Salmeterol): 12 hours |
|
|
Short acting beta 2 agonists are used for:
|
Short acting beta 2 agonists are used for mild Stage 1 COPD and also as a rescue medication in the other stages
|
|
|
True or False: There has been extensive evidence to link increased risk of mortality with the use of beta 2 agonists.
|
False: There has been insufficient evidence to link increased risk of mortality with the use of these agents
|
|
|
Anticholinergic agents MOA
|
Blocking effect of acetylcholine on M3 receptors. Tiotropium also acts on the M1 receptors.
|
|
|
The effect of short acting inhaled anticholinergics last for________________________
|
8 hours
|
|
|
The effect of (long acting anticolinergic) Tiotropium lasts for__________________.
|
The effect of Tiotropium lasts for >24 hrs
|
|
|
Tiotropium decreases _______________, which improves exercise endurance, decreases dyspnea and reduces exacerbations.
|
Tiotropium decreases hyperinflation, improves exercise endurance, decreases dyspnea and reduces exacerbations
|
|
|
Is there a benefit of using Tiotropium and a short acting anticolinergic together?
|
no dont use them together. Replaces receptors.
|
|
|
Theophylline use:
|
-Modest bronchodilator effect and some symptomatic benefit compared with placebo in stable COPD. Addition of theophylline to salmeterol produces a greater increase in FEV1 and breathlessness than salmeterol alone.
*Low dose theophylline reduces exacerbations but does not improve post-bronchodilator lung function. |
|
|
Theophylline effectiveness:
|
-Is less effective and less well tolerated than inhaled LABA and is not recommended if those drugs are available and affordable.
|
|
|
inhaled corticosteriods use:
|
Regular treatment with inhaled corticosteroids (ICS) improves symptoms, lung function and quality of life and ***reduces frequency of exacerbations*** for COPD patients with an FEV1 < 60% predicted.
|
|
|
Inhaled corticosteroid therapy is associated with an increased risk of _______________________.
|
Inhaled corticosteroid therapy is associated with an increased risk of pneumonia.
|
|
|
Withdrawal from treatment with inhaled corticosteroids:
|
Withdrawal from treatment with inhaled corticosteroids may lead to exacerbations in some patients.
SO TAPER: go from twice daily use to once daily use.... |
|
|
Combination therapy
|
An inhaled corticosteroid combined with a LABA is more effective than the individual components in improving lung function and health status and reducing exacerbations in moderate to very severe COPD.
In moderate&severe COPD you will see this. |
|
|
Combination therapy is associated with an increased risk of ________________________.
|
Combination therapy is associated with an increased risk of pneumonia.
|
|
|
True or false: Addition of a long-acting beta2-agonist/inhaled glucorticosteroid combination to an anticholinergic (tiotropium) appears to provide additional benefits.
|
True: All three show benefits
In moderate&severe COPD you will see this, as well. |
|
|
Chronic treatment with systemic corticosteroids should be ______________ because:
|
Chronic treatment with systemic corticosteroids should be avoided because of an unfavorable benefit-to-risk ratio.
|
|
|
Short courses of oral cortico-steroids:
|
Short courses of oral cortico-steroids predict a poor response to inhaled corticosteroids long term
|
|
|
Phosphodiesterase-4 Inhibitors use:
|
In patients with severe and very severe COPD (GOLD 3 and 4) and a history of exacerbations and chronic bronchitis...
Phospodiesterase-4 inhibitor (PDE-4), roflumilast, reduces exacerbations treated with oral glucocorticosteroids. (Helps so you do not have to use oral steroids) |
|
|
Indication for using antibiotics in COPD
|
The use of antibiotics, other than for treating infectious exacerbations of COPD and other bacterial infections, is currently not indicated.
antibiotic of choice: Macrolides: azithromycin, due to possible anti-inflammatory action that works on bronchioles. |
|
|
Alpha-1 antitrypsin augmentation therapy
|
Alpha-1 antitrypsin augmentation therapy: not recommended for patients with COPD that is unrelated to the genetic deficiency.
|
|
|
Mucolytics in copd
|
Mucolytics: Patients with viscous sputum may benefit from mucolytics; overall benefits are very small.
|
|
|
Antitussives in copd
|
Antitussives: Not recommended.
|
|
|
Vasodilators in copd
|
Vasodilators: Nitric oxide is contraindicated in stable COPD. The use of endothelium-modulating agents for the treatment of pulmonary hypertension associated with COPD is not recommended.
|
|
|
Acute exacerbations are characterized by:
|
Characterized by:
Increased sputum production Increased sputum purulence Worsening dyspnea |
|
|
Acute exacerbations etiologies:
|
Etiologies:
Infection Allergens, pollutants Inhaled irritants |
|
|
Acute Exacerbations: Pharmacologic Therapy
|
-Oxygen
-Bronchodilators: Start with short acting beta-2 agonists (use as much as the pt needs- worst side effects will be jitteriness and tachycardia), Anticholinergics (ipertropium- use as much as you need) -Glucocorticosteroids Oral or IV (30-40 mg of prednisolone PO x 7-10 days) -Antibiotics -Dyspnea, sputum volume, sputum purulence |
