COPD

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Author:
wcameron
ID:
220019
Filename:
COPD
Updated:
2013-05-19 21:07:30
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COPD
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COPD
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  1. Definition of COPD
    - airflow limitation (obstruction) that is not fully reversible.

    - progressive inflammatory disease with hypersensitive reactions to noxious stimuli

    - involves the parenchyma AND small airways (bronchioles)

    • - COPD is preventable and treatable
  2. What conditions/diagnoses are under the COPD umbrella?
    emphysema

    chronic bronchitis

    bronchiectasis
  3. Definition/diagnosis of Chronic bronchitis
    Chronic, persistent cough and/or sputum production for 3 consecutive months each year for 2 consecutive years with periodic acute exacerbations (symptoms worsen).
  4. Definition of Emphysema
    Enlargement of air spaces secondary to alveolar wall destruction

    Alveolar wall destruction probably secondary to neutrophil-produced elastases - without elastin, the airways collapse upon expiration.
  5. Diagnosis of COPD (general)
    Spirometry - PFT's necessary for diagnosis, staging, and monitoring.

    Subjective symptoms may not be present & are not necessary for diagnosis.

    Consider if: 

    • - age over 40
    • - dyspnea (progressive, worse with exercise, persistent)
    • - chronic cough
    • - chronic sputum production
    • - Hx of exposure to risk factors
  6. Symptoms of COPD
    - cough

    - sputum production

    - dyspnea on exertion

    - 40-50% loss of lung capacity before symptoms begin
  7. Risk Factors for COPD
    Genetic (alpha-1 antitrypsin deficiency) AAT

    Exposure to inhaled irritants (tobacco, occupational dust/chemicals, air pollution)
  8. Spirometry
    2 Most effective measures:

    FEV1 (forced expiratory volume in the 1st second of expiration)

    FVC (forced vital capacity)

    *** FEV1 to FVC ratio = considered the most sensitive indicator of early airflow limitation ***
  9. Spirometry evidence of obstruction if FEV1/FVC is < _______.
    70%
  10. GOLD initiative
    Created to increase awareness & disseminate research.
  11. GOLD Stages of COPD (0)
    At Risk: Normal spirometry, chronic symptoms of cough or sputum production
  12. GOLD Stage I
    Mild COPD; FEV1/FVC < 70%, FEV1 > or = 80%, with or without chronic symptoms of cough & sputum prod.
  13. GOLD Stage II
    Moderate COPD; FEV1/FVC <70%, FEV1 50-80% with or without chronic symptoms of cough, sputum prod., dyspnea
  14. GOLD Stage III
    Severe COPD

    FEV1/FVC < 70%

    FEV1 30-50%

    w/ or w/o symptoms
  15. GOLD Stage IV
    Very severe COPD

    FEV1/FVC < 70%

    FEV1 30-50% 

    +

    Respiratory failure (PaO2 < 60 with or without PaCO2 > 50)
  16. COPD Treatment (All stages)
    Avoidance of risk factors (smoke)

    Influenza vaccine
  17. COPD treatment (Stage I)
    Short acting bronchodilator when needed
  18. COPD Treatment (Stage II)
    Short-acting bronchodilator PRN 

    Long-acting bronchodilator

    Pulm. Rehab.
  19. COPD Treatment (Stage III)
    SABA PRN

    LABA

    Pulm.Rehab.


    - INH glucocorticosteroids if sign. symptoms, or if repeated exac.
  20. COPD Treatment (Stage IV)
    SABA PRN

    LABA + Inh. corticosteroid

    Tx complications

    Pulm. Rehab.

    O2 therapy if failure

    * consider surgical options
  21. Antibiotics in COPD
    • Only shown to be useful in acute exacerbations with
    • breathlessness and cough that are assoc. with altered sputum production (change
    • in color, consistency, amount).

    Low risk for resistance: tetracycline, bactrim.

    • 2nd gen. cephalosporins: cefuroxime, cefaclor,
    • cefprozil.

    • Macrolides: clarithromycin (biaxin) effective in
    • uncomplicated acute bronchitis. Azithromycin.

    • 3rd gen. cephalosporins: cefdinir (omnicef),
    • cefoperazone, ceftibuten VERY EFFECTIVE and few interactions.
  22. Bacterial pathogens common in COPD exac
    S.Pneumoniae

    H.Influenza

    M.Catarrhalis
  23. First line therapy for COPD
    Beta-2 agonist is first line therapy

    Inh.anticholinergics 2nd line

    Theophylline 3rd line
  24. Antibiotics for selected pathogens
    doxycycline

    bactrim

    amoxicillin

    augmentin

    azithromycin

    cephalosporins
  25. Sleep related hypoxemia
    increased hematocrit

    morning headaches

    daytime somnolence

    intense snoring

    Dx established with pulse oximetry
  26. Cor Pulmonale
    Right-heart failure secondary to lung disease

    P.E.: peripheral edema, JVD, congested liver

    EKG: RV hypertrophy and right axis deviation
  27. Emphysema
    • Form of COPD characterized by destruction of the alveolar
    • walls due to imbalance of enzyme activity in lungs.

    • Characterized by air trapping, increased residual
    • lung volume, decreased expiratory flow, retained CO2

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