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36 Cards in this Set
- Front
- Back
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List 3 external risk factors for COPD.
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1. Tobacco smoke
2. Occupational exposures (miners, grain dust, cotton dust) 3. Environmental pollution |
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List 4 intrinsic risk factors for COPD
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1. Genetics
2. Men > Women 3. Impaired lung development 4. Bronchial hyperreactivity |
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How does occupational exposure to mineral dusts, plant dusts, and certain gasses compare to tobacco use resulting in COPD?
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The effect of mineral dusts, plant dusts, and gases is about 1/6 that of smoking
*Both contribute to accelerated decline of FEV1, but the decline is much faster with smoking |
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In ALL smokers, where does respiratory inflammation occur?
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Small airways
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Do inflammatory responses persist in patients with COPD after smoking cessation?
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Yes
This differs from non-COPD patients, in which smoking cessation will lead to decline of inflammatory cells |
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What are the 3 main conditions that can lead to COPD?
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1. Chronic bronchitis
2. Emphysema 3. Small airway disease |
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What is the earliest site of inflammation in smokers?
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Small airway disease
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What is the MAJOR site of increased airway resistance in COPD?
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Small airways
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Small airway disease occurs in ariways <______mm.
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< 2 mm
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Which condition contributes a lot to the symptomology (cough, mucus production) of COPD, but is thought to play a minor role in increased airway resistance?
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Chronic bronchitis
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Compare the ratio of FEV1/FEV1 at age 25 between Non-smokers and non-susceptible smokers.
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Non-susceptible smokers have similar ratio to people who don't smoke
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What is the effect of chronic bronchitis on airway resistance?
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Minor effect
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What is the effect of respiratory bronchiolitis on airway resistance?
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Increases airway resistance
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What are the 2 effects of emphysema on airway resistance?
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1. Loss of tethering effect on small airways
2. Loss of elastic recoil and driving pressure for expiratory flow. *Leads to increased resistance |
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What happens to the TLC in COPD?
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Can be normal or increased
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What happens to the RV in COPD?
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increased
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What happens to the VC and RV values in COPD with airtrapping?
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VC decreases
RV increases disproportionately |
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What happens to VC in COPD?
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Normal or decreased (with airtrapping)
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What happens to elastic recoil with ephysema?
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Decreases
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What happens to elastic recoil with fibrosis?
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Increases
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List 5 symptoms of COPD
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1. Dyspnea
2. Cough 3. Sputum 4. Wheeze 5. Hemoptysis (check for lung cancer!) |
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List 6 clinical signs of COPD
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1. Decreased air sounds and prolonged expiratory phase
2. Adventitious sounds (wheezing, ronchi, early inspiratory crackles) 3. Diminished heart sounds 4. Accessory muscle use 5. Pursed lip breathing 6. Tripod positioning |
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Why should you be concerned if you notice digital clubbing in a patient with COPD?
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Can be a manifestation of lung cancer
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What sort of FEV1/FVC ratio is characteristic of COPD?
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Decreased
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What are some lab findings seen in patients with COPD?
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1. Normal or low FVC
2. Low FEV1, and low FEV1/FVC ratio 3. Increased TLC and RV 4. Low DLCO 5. Hypoxemia (V/Q mismatch) 6. Normocapnia or hypercapnia 7. Hyperinflation on chest x-ray |
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What are some treatments for COPD?
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1. Smoking cessation (or reduce other risk factors)
2. Immunizations (flu, pneumococcal) 3. B2-agonists, antimuscarinics, inhaled corticosteroids 4. Antibiotics 5. Supplemental O2 6. Pulmonary rehabilitation 7. Surgical options |
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What three therapies are used for all stages of COPD?
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1. Risk factor reduction (smoking cessation)
2. Immunizations 3. Short-acting bronchodilators |
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For moderate to very severe COPD, which 2 additional therapies are suggested?
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1. Long-acting bronchodilators
2. Rehabilitation |
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For severe to very severe COPD, which additional therapy is suggested?
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Inhaled corticosteroids for frequent exacerbations
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What therapies are recommended for very severe COPD?
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1. Long-term O2
2. Surgical options |
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What are the "5 A's" to encourage smoking cessation?
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ASK --> Identify tobacco use at every visit
ADVISE --> Strongly urge all users to quit ASSESS --> Determine willingness to quit ASSIST--> Aid the patient in quitting ARRANGE --> schedule follow-up contact |
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What are the 4 components of Pulmonary Rehabilitation in COPD?
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1. Exercise training
2. Calorie supplements 3. Self-management education 4. Psychosocial assessment and intervention |
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Does exercise training in COPD patients improve lung function?
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No.
However, exercise capacity is improved |
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Does pulmonary rehabilitation reduce dyspnea?
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Yes
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What sort of therapy can be used to improve survival in patients with SEVERE resting hypoxemia?
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Outpatient oxygen
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What sort of arterial PO2 and arterial O2 saturation levels are required to qualify a patient for outpatient oxygen therapy?
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PaO2 =or< 55 mmHg
SaO2 =or< 88% *If values are slightly higher than this, and the patient has evidence of END-ORGAN DAMAGE, the patient is also qualified for oxygen therapy |
