Card Set Information
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
What conditions/diagnoses are under the COPD umbrella?
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).
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.
Diagnosis of COPD (general)
Spirometry - PFT's necessary for diagnosis, staging, and monitoring.
Subjective symptoms may not be present & are not necessary for diagnosis.
- age over 40
- dyspnea (progressive, worse with exercise, persistent)
- chronic cough
- chronic sputum production
- Hx of exposure to risk factors
Symptoms of COPD
- sputum production
- dyspnea on exertion
- 40-50% loss of lung capacity before symptoms begin
Risk Factors for COPD
Genetic (alpha-1 antitrypsin deficiency) AAT
Exposure to inhaled irritants (tobacco, occupational dust/chemicals, air pollution)
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 ***
Spirometry evidence of obstruction if FEV1/FVC is < _______.
Created to increase awareness & disseminate research.
GOLD Stages of COPD (0)
At Risk: Normal spirometry, chronic symptoms of cough or sputum production
GOLD Stage I
Mild COPD; FEV1/FVC < 70%, FEV1 > or = 80%, with or without chronic symptoms of cough & sputum prod.
GOLD Stage II
Moderate COPD; FEV1/FVC <70%, FEV1 50-80% with or without chronic symptoms of cough, sputum prod., dyspnea
GOLD Stage III
FEV1/FVC < 70%
w/ or w/o symptoms
GOLD Stage IV
Very severe COPD
FEV1/FVC < 70%
Respiratory failure (PaO2 < 60 with or without PaCO2 > 50)
COPD Treatment (All stages)
Avoidance of risk factors (smoke)
COPD treatment (Stage I)
Short acting bronchodilator when needed
COPD Treatment (Stage II)
Short-acting bronchodilator PRN
COPD Treatment (Stage III)
- INH glucocorticosteroids if sign. symptoms, or if repeated exac.
COPD Treatment (Stage IV)
LABA + Inh. corticosteroid
O2 therapy if failure
* consider surgical options
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,
: clarithromycin (biaxin) effective in
uncomplicated acute bronchitis. Azithromycin.
3rd gen. cephalosporins
: cefdinir (omnicef),
cefoperazone, ceftibuten VERY EFFECTIVE and few interactions.
Bacterial pathogens common in COPD exac
First line therapy for COPD
Beta-2 agonist is first line therapy
Inh.anticholinergics 2nd line
Theophylline 3rd line
Antibiotics for selected pathogens
Sleep related hypoxemia
Dx established with pulse oximetry
Right-heart failure secondary to lung disease
P.E.: peripheral edema, JVD, congested liver
EKG: RV hypertrophy and right axis deviation
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