Indications for home O2
PaO2 55%
Titrate PaO2 to 60-65% (spO2 > 90)
Home O2 for 15 hr/day, only for non-smokers
Shown to reduce complications of chronic hypoxia and increased daily activities independence
Vaccinations in pts with COPD
Flu vaccine yearly
Pneumococcal vaccine at least once and repeated in 5-10 years
COPD to consider when determining pharmacotherapy
- Symptoms (MRDC scale 0-1, >2)
- # exacerbations (2/year)
- Gold class (1-2 or 3-4)
LAAC what does it improve
-lung function (debatable)
-decreased symptoms (dyspnea)
-decreased exacerbations
-improves exercise tolerance
?mortality
LABA what does it improve
- lung function
- decreases symptoms (dyspnea)
- decreases exacerbations
- no effect on mortality OR exercise tolerance
LAAC and LABA what does it improve
- improvement in health status
- may improve lung function(some studies for, some against)
- does not reduce frequency or severity of exacerbations
Addition of ICS to to LABA benefits
TORCH study
- Decreased # exacerbations (NNT 4 for exacerbation/year; counterbalanced by increased risk of pneumonia associated with ICS NNH 17)
- Improvement in PFT
- improve symptoms
- Trend twds decreasing mortality
Benefit of quitting smoking for COPDer
Low evidence for preventing exacerbations
-outstanding in improving COPD prognosis, slowing lung function decline, improvement QOL and symptoms
Benefit of pulmonary rehab for COPDer
- For pts with mod-very severe COPD provided within 4 weeks of exacerbation
- can prevent exacerbations
- improve symptoms/QOL, exercise tolerance
Definition of asthma
Increase of FEV or FVC >12% or > 200 cc
Abnormal DLCO
Normal FEV1
lower limit of normal if 80%
Air trapping
Definition TLC > 120% predicted
Fixed upper airway obstruction characteristic pattern on Flow volume loop
Flattening of both inspiratory and expiratory limbs of flow volume loop
Variable intrathoracic obstruction results in what feature on flow volume loop
Flattening of expiratory limb (top)
Example could be carcinoid tumor of bronchus
Variable extrathoracic obstruction results in what feature on flow volume loop
Flattening of inspiratory limb (bottom)
Examples could be thyroid tumor
Restrictive lung disease definition
FEV1/FVC normal or increased
TLC
Restrictive lung disease differential
Think PAINT Pleural -trapped lung -pleural scarring -large pleural effusion -chronic empyema -asbestosis
Alveolar
- edema
- hemorrhage
Interstitial
-ILD including IPF, NSIP, COP
Neuromuscular
-Myasthenia Gravis/ALS myopathy
Thoracic/extrathoracic
- Obesity
- Kyphoscoliosis
- Ascites
