Chapter 70: COPD

Question 1

Global Initiative for Chronic Obstructive Lung Disease COPD definition encompasses:

Answer 1

chronic bronchitis, emphysema, bronchiectasis, and asthma

Question 2

major risk factor for COPD

Answer 2

tobacco Smoke

*a1-Antitrypsin deficiency accounts for <1% of COPD patients

Question 3

Hallmark symptoms of COPD

Answer 3

• Chronic and progressive dyspnea
• cough
• sputum production

Question 4

confirmed chronic, compensated COPD if postbronchodilator spirometry FEV1/FVC is __

Answer 4

<0.7

Question 5

Classify COPD Severity: FEV1 ≥80% predicted

Answer 5

Mild COPD

Question 6

Classify COPD Severity: FEV1 between 50% and 79% predicted

Answer 6

Moderate COPD

Question 7

Classify COPD Severity: FEV1 between 30% and 49% predicted

Answer 7

Severe COPD

Question 8

Classify COPD Severity: FEV1 <30% predicted

Answer 8

Very severe COPD

Question 9

CXR findings in emphysema

Answer 9

• hyperaeration
• increased anteroposterior chest diameter
• flattened diaphragms
• increased parenchymal lucency
• attenuation of pulmonary arterial vascular shadows

Question 10

B-type natriuretic peptide level __ supports a diagnosis of COPD

Answer 10

<100 picograms/mL

Question 11

Criteria for long-term oxygen therapy

Answer 11

• PaO2 <55 mm Hg
• SaO2 <88%
• PaO2 bet 56 and 59 mm Hg when pulmonary hypertension, cor pulmonale (sustained right ventricular failure), or polycythemia is present

Question 12

TRUE or FALSE: in COPD, Most prefer inhaled long-acting β2-agonists for baseline care over short-acting formulations

Answer 12

TRUE

• salmeterol, formoterol, olodaterol, and indacaterol, are options. Short-acting inhaled β2-agonists, usually albuterol, are added as needed

Question 13

TRUE or FALSE: short-acting anticholinergic agents, such as ipratropium bromide or oxitropium bromide are preferred over long-acting agents, such as tiotropium, aclidinium, umeclidinium, and glycopyrronium

Answer 13

FALSE

Question 14

TRUE or FLASE: Daily azithromycin may decrease acute exacerbations in older patients and those with milder COPD

Answer 14

TRUE

Question 15

in COPD, expectorants are of clear benefit when it comes to secretion mobilization

Answer 15

FALSE

• Mobilize respiratory secretions with generous oral fluid intake and room humidification

Question 16

The only intervention that can reduce both the rate of decline in lung function and mortality from respiratory cause in COPD

Answer 16

Smoking cessation

Question 17

TRUE or FALSE: Acute exacerbations of COPD are primarily due to expiratory airflow limitation

Answer 17

FALSE

• Acute exacerbations of COPD are primarily due to ventilation–perfusion mismatch rather than the expiratory airflow limitation seen with asthma exacerbations

*Supplemental oxygen increases blood oxygen concentrations and can help reverse pulmonary vasoconstriction

Question 18

final common pathway for COPD exacerbation

Answer 18

release of inflammatory mediators that result in:
- bronchoconstriction
- pulmonary vasoconstriction
- mucus hypersecretion

Question 19

first-line therapies in the management of acute, severe COPD

Answer 19

Short-acting β2-agonists

• ß2-Agonists are best given every 30 to 60 minutes if tolerated

Question 20

most common adverse effect of Corticosteroids

Answer 20

Hyperglycemia

Question 21

most common pathogens associated with COPD exacerbation

Answer 21

Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis

Question 22

Indications for Noninvasive Ventilation

Answer 22

• Acidosis (pH <7.36)
• hypercapnia (Paco2 >50 mm Hg)
• oxygenation deficit (Pao2 <60 mm Hg or Sao2<90%)
• Severe dyspnea with clinical signs such as respiratory muscle fatigue or increased work of breathing