Pulmonary - COPD

Question 1

What is COPD?

What is the mechanism? - A picture

Answer 1

deterioration of small airways because of the chronic inflammation

Question 2

How is the gas exchange of COPD?

Answer 2

mismatched perfusion @ capillary membrane = hypoxemia

Question 3

How does hypoxemia progress to?

Answer 3

hypercapnia (increased CO2 in the arterial blood) = pulmonary hypertension

Question 4

The progression of COPD contributes to what?

Answer 4

Decreased O2 in arterial blood

Question 5

What are the possible causes of COPD?

Answer 5

• loss of elastic recoil = collapsed airway (air trap)
• walls between alveoli are destroyed and dilation of alveolar spaces
• increased compliance of lung tissue
• more mucus = clogged airways
• normal exhalation = thorax returned to resting position

Question 6

What does the closed airway contribute to?

Answer 6

cyclic hyperinflation = thorax can’t go back to resting position

Question 7

What is the prevalence of COPD?

Answer 7

• 3rd leading cause of death
• 4th leading cause of death in the U.S in general
• 1 in 5 have COPD
• 16 milly+
• gets lots of ER visits

Question 8

What is the general demographics of COPD?

Answer 8

• over 40 with increased age around 65-75
• women more than men
• smoking (duh)
• lower income
• unemployed, retired and disable
• increased risk in SE and MW regions
• rural areas more likely

Question 9

What is the most common cause of COPD regarding demographics?

Answer 9

Smoking (80%)
never smoked (10-25%)
Poor air quality

Question 10

What are the risk factors of COPD?

Answer 10

occupational exposure
exposure to air pollution
age
cigarette smoking
childhood respiratory conditions
genetics

Question 11

What are the important components for the patient hx?

Answer 11

1. former/current smoker
2. exposure to passive smoking
3. environmental exposures
4. occupational dusts and chemicals
5. hx of childhood respiratory conditions
6. older age
7. family hx
8. SOB with activity

Question 12

What is the common clinical presentation?

Answer 12

• most common sx = dyspnea
• chronic cough
• barrel chest
• wheezing
• reduced or absent breath sounds
• retain CO2

For dyspnea - usually with exertional activities / worsens over time and becomes apparent with lower-level ADL

Question 13

COPD testing

What does spirometry measure for pulmonary function testing?

Answer 13

time-volume relationships in the lungs

The gold standard

Question 14

COPD testing

Obstructive disease is characterized by?

Answer 14

Delay and incomplete emptying of the lung during exhalation which would benefit from testing to diagnose

Question 15

COPD PFT

What is the process of PFT-spirometry?

Answer 15

Two forced expiratory volumes monitored are forced expiratory volume in 1-sec and forced vital capacity

FEV1/FVC ratio = >75% is normal

Question 16

COPD PFT

What is used for?

Answer 16

Used to quantify degrees of airway obstruction, document baseline and follow progression of disease

demonstrate altered volumes and capacity over time = air trapping

Question 17

What is the classifications of COPD severity?

Answer 17

mild = add short-acting bronchodilator
mod = add long-acting brochodilator + rehab
severe = add inhaled corticosteroids
very severe = add O2 if respiratory failure (possible surgical options)

Question 18

What is the grades of breathlessness?

Answer 18

Question 19

What is BODE index? What is it’s purpose?

Answer 19

A multidimensional index for severity of COPD
= good predictor of survival and hospitalization
= BODE is btter predictor than FEV1 alone

Question 20

BODE Index

0 to 2 points indicates?

Answer 20

80% survival

Question 21

BODE Index

3 to 4 points indicates?

Answer 21

67% survival

Question 22

BODE Index

5 to 6 points indicate?

Answer 22

57% survival

Question 23

BODE Index

7 to 10 points indicate?

Answer 23

18% survival

Question 24

What is the medical management for COPD?

Answer 24

• stop smoking LOL
• pharmacotherapy
• influenze vaccine
• pneumonia vaccine
• treatment of sleep disorders
• pulmonary rehab - exercise training
• surgery

Question 25

What are the drugs used for COPD?

Answer 25

Mucolytics bronchodialtors steroids

Question 26

What is emphysema?

Answer 26

condition of the lung where the alveolar walls are destroyed and enlargement of airspaces distal to terminal bronchioles

Question 27

What is the clinical presentation of chronic bronchitis?

Answer 27

- having a cough for 3 months in each of 2 successive years - the use of accessory muscles - elevated shoulder - barrel chest - fatigue - anxiety

Question 28

# Chronic bronchitis Where does hypersecretion start?

Answer 28

starts at large airways and goes to smaller airways = hypertrophy of submucosal glands

Question 29

Appearance of emphysema vs chronic bronchitis | ISSA PICTURE

Answer 29

Question 30

What is the clinical presentation of chronic bronchitis?

Answer 30

thorax ROM - decreased excursion - muscle of ventilation is stretched - diaphragm can't return to dome shape on exhalation = flattens over time