Lecture 4: COPD

Question 1

How many pack/years smoking hx, age, and maximum laryngeal height are the most predictive of COPD?

Answer 1

• >40 pack-year smoking hx
• ≥45 y/o
• Maximum laryngeal height ≤4 cm

Question 2

All patients who have unexplained dyspnea and cough should be evaluated for what?

Answer 2

α₁-AT deficiency

Question 3

Cardiac exam of pt with COPD may show what?

Answer 3

• Cor pulmonale
• ↑ intensity of the pulmonic sound, persistently split S2
• Parasternal lift due to RVH

Question 4

Using the GOLD criteria for staging COPD what are the characteristics of stage I through stage IV?

Answer 4

• I (mild) = FEV1 ≥80% of predicted
• II (moderate) = 50% ≤FEV1 <80%
• III (severe) = 30% ≤FEV1 <50%
• IV (very severe) = FEV1 <30% of predicted or FEV1 <50% of predicted plus chronic respiratory failure

*All have FEV1/FVC <70%

Question 5

Using the GOLD criteria for staging COPD what are the characteristics of stage II - moderate?

Answer 5

• FEV1/FVC <70%; 50% ≤FEV1 <80% of predicted

Question 6

Which postbronchodilator value of FEV1 and FEV1/FVC ratio confirms the presence of nonreversible obstruction?

Answer 6

• FEV1 <80% of predicted
• FEV1/FVC ratio <70%

Question 7

Severity of COPD can be graded using the BODE index which consists of what?

Answer 7

• BMI
• Airflow Obstruction
• Dyspnea
• Exercise capacity (the 6-minute walk distance)

Question 8

Which BMI gives you 1 point using the BODE index?

Answer 8

≤21 = 1 point

Question 9

Using the BODE index which FEV1 % predicted after bronchodilator gives 0-3 points?

Answer 9

• ≥65% = 0
• 50-64% = 1
• 36-49% = 2
• <35% = 3

Question 10

Using the BODE index which 6-minute walk distances are associated with a score of 0-3?

Answer 10

• ≥350 meters = 0
• 250-349 = 1
• 150-249 = 2
• ≤149 = 3

Question 11

Using the points from the BODE index, how many points are associated with 4-year survival % of 80, 67, 57, and 18?

Answer 11

• 0-2 = 80%
• 3-4 = 67%
• 5-6 = 57%
• 7-10 = 18%

Question 12

What is Hoover’s sign?

Answer 12

• Inward movement of the lower rib cage during inspiration, instead of outward as is normal
• Implies a flat, but functioning, diaphragm

Question 13

What are the 2 suffixes for inhaled corticosteroids?

Answer 13

• -asone (i.e., fluticasone)
• -ide (i.e., budesonide)

Question 14

In milder and younger pt’s w/ COPD (FEV1 >50% and age <65) which 4 antibiotic classes are used?

Answer 14

• Doxycycline
• TMP-SMX
• Cephalosporin (cefuroxime, cefdinir, cefopodoxime)
• Advanced macrolide (azithromycin, clarithromycin)

Question 15

In sicker older pt’s with COPD which 2 antibiotic classes are utilized?

Answer 15

• Amoxicillin-clavulunate
• Fluoroquinolones (FDA warning - Achilles tendon rupture)

Question 16

Which PaO₂ or SpO₂ values measured 2x over a 3-week period would be indications for supplemental O₂?

Answer 16

• PaO₂ ≤55 mmHg

or

• SpO₂ ≤88%

Question 17

Supplemental O₂ is indicated in pt’s with PaO₂ >56 but <60 any time with evidence of what 3 underlying conditions?

Answer 17

• Pulmonary HTN
• CHF
• Erythrocytosis Hct >55%

Question 18

For patient with GOLD I: mild COPD what is the standard tx?

Answer 18

Either SABA or SAMA prn; often ordered together as Combivent

Question 19

For patient with GOLD II: moderate COPD what is the standard tx?

Answer 19

LABA or LAMA

Question 20

For patient with GOLD III: severe COPD what is the standard tx?

Answer 20

• ICS + LABA or ICS + LAMA (NEVER use ICS alone in COPD)
• With or without either roflumiast or theophylline

Question 21

Which drug used in tx of COPD is NEVER used alone in COPD?

Answer 21

ICS

Question 22

For patient with GOLD IV: very severe COPD what is the standard tx?

Answer 22

• ICS + LABA or ICS + LAMA or ICS + LAMA + LABA
• With or without roflumilast or theophylline

Question 23

What 3 surgical interventions may improve sx’s of COPD in highly selected pt’s?

Answer 23

• Bullectomy
• Lung volume reduction surgery
• Lung transplantation

Question 24

Treatment of COPD is stepwise and largely based on what?

Answer 24

PFT’s

Question 25

What are the 3 most common bacteria responsible for pneumonia in COPD?

Answer 25

- *S. pneumoniae* - *M. catarrhalis* - *H. influenzae*