COPD

Question 1

in COPD diagnosis, the FEV1/FVC ratio is ___ and the ___ decreases in proportion to the severity of emphysema, not sensitive for mild disease.

Answer 1

in COPD diagnosis, the FEV1/FVC ratio is REDUCED and the DLCO decreases in proportion to the severity of emphysema, not sensitive for mild disease.

Question 2

is COPD obstructive or restrictive lung disease?

Answer 2

obstructive. in order to diagnose COPD, there must be FIXED airflow obstruction on spirometry; FEV1/FVC less than 0.7 or the lower limit of normal.

post bronchodilator FEV1 tells you severity of airflow obstruction.

• Asthma is still a condentor on diagnosis

Question 3

DDx of COPD

Answer 3

• asthma
• bronchiectasis
• GERD
• cancer/malignancy/central airway obstruction
• heart failure
• TB
• possible nodules
• bronchiolitis (obliterative) post bone marrow transplant.

Question 4

there are intrathoracic and extrathoracic causes of chronic cough

Question 5

which side of the heart has failure if a person has chronic cough

Answer 5

left heart failure. recall that “systemic” problems are more likely to be LS problems

• generally, right sided heart problems result in JVP issues and edema and pulmonary edema.

Question 6

risk facors for COPD

Question 8

ourlint intrinsic and extrinsic airway fractors that create the COPD expiratory flow limitation

Answer 8

intrinsic factors: mucosal edema, inflammation, airway remodeling and secretions

extrinsic airway factors: reduced airway tethering form emphysema

Question 9

is this COPD?

Answer 9

no. the post drug change is over 20% after bronchodilator. While it is obstructive, it’s probably asthma rathern than COPD

Question 10

Is this COPD?

Answer 10

the FEV1/FVC ratio has to be less than .7. right now its 79. It’s restrictive lung disease– stiff lungs

Question 11

Is this COPD?

Answer 11

Yes. Ratio below .7– indication obstruction. inspiratory curve is sloped

Question 12

findings on chest X ray for COPD

Answer 12

– normal
– low flat diaphragms
– increased retrosternal airspace: check ribs anterior and posterior, and lateral xray
– low tapered heart shadow
– rapid tapering of the vessels with hyperlucency
of the lung – Usually characteristic changes on CXR in severe
COPD, 50% of the time in moderate COPD

Question 13

T/F: COPD manifests small airway disease and parenchymal destruction

Answer 13

true.

Question 14

interpret CT scan

Answer 14

there are small little gas trapping asepcts. this is COPD. Emphysematous.

Question 15

irreversible and reversible causes of airflow limitation

Answer 15

1. irreversible: fibrosis and narrowing of the airway.s loss of elastic recoil due to alveolar destruction. destruction of alveolar support that maintains patency of small airways.
2. reversible
   - accumulation of inflammatory cells, mcus and plasma exudate in bronchi
   - smooth muscle contraction in peripheral and central airways
   - dynamic hyperinflation during exercise.

Question 16

Question 17

whats going on

Answer 17

chronic bronchitis theres lots of mucous gland pits

Question 18

Question 19

how does the dead space change in people with COPD

Answer 19

patients with COPD has a higher dead space.

Question 20

determination of COPD severity:

Answer 20

Question 21

comprehensive management of COPD

Answer 21

• educatiton
• vaccination
• short acting bronchodilator prn
• integrated care
• inahled long acting therapies
• pulmonary rehabilitation
• oral therapies
• long term oxygen therapy
• lung transplantation.

Question 22

T/F pulmonary rehabilitation increases quality of life

Answer 22

true. improves exercise capacity and health related quality of life.

Question 23

5 A’s of smoking cessation

Answer 23

• Ask the patient about tobacco use
• Advise the patient to quit
• Assess the patient’s willingness to make a quit attempt
• Assist the patient to make a quit attempt by offering counselling or pharmacotherapy
• Arrange follow-up with the patien

Question 24

mainstay of COPD steroids

Answer 24

pharmacotherapy: bronchodilators.

“They can reduce air trapping (hyperinflation) and dyspnea, and improve quality of life even if there
is no improvement in FEV1”

Question 25

how does forced vital capacity and residual volume change in COPS?

Answer 25

there is a larger reduced volume resulting in a small forced vital capacity.

Question 26

TF if there is a high chance of exacerbation, you should give a SABA

Answer 26

false. immediate LAMA/LABA or ICS/LABA

Question 27

T/F ICS alone can be used as a treatment alone for COPD

Answer 27

false. there is no role for ICS alone. - ICS/LABA combinations (evidence that they reduce AECOPD for those at high risk)

Question 28

affect of metabolic rate by COPD

Answer 28

may have very high basal metabolic rate because it takes a lot of energy to breathe. Patients with COPD might have muscle weakness, osteoporosis, weight loss.

Question 29

Compare asthma and COPD

Answer 29

Question 30

preventing AECOPD

Answer 30

Question 31

meds for AECOPD exacerbation

Answer 31

- LAMA/LABA or ICS/LABA - SABA * *Systemic corticosteroids** - Oxygen - SABA - antibiotics

Question 33

Antibiotic treatment for complicated or simple exacerbation.

Answer 33