Chronic Bronchitis, Emphysema, & Airway Obstruction
Questions from the 1st PowerPoint presentation with some of the syllabus notes mixed in.
Terms in this set (88)
What is a chronic disease characterized by alveolar, airway, and systemic inflammation with airway obstruction?
What is the term used to describe permanent or minimally reversible obstruction of expiratory airflow caused by emphysema or chronic bronchitis?
COPD or CAO
What causes permanent tissue damage if the body's repair and protective and mechanisms are overwhelmed?
Mucous gland hypertrophy, narrowing and fibrosis of the airways, destruction of lung parenchyma, and change in pulmonary vessels are the result of what process?
What is the 3rd leading cause of death in the United States?
What is the 10 year mortality rate for a patient recently diagnosed with COPD?
This condition is characterized by hypersecretion of mucus and structural changes in the bronchi.
Which condition includes inflammation, squamous metaplasia of the epithelium, and enlargement of mucous glands?
In order to diagnose chronic bronchitis, there must be a presence of a cough and sputum how often for how many years in succession?
Most days for at least 3 months of the year; minimum of 2 years in succession
What causes acute bronchitis?
T/F: You can have chronic bronchitis without pulmonary function changes.
What are the 2 most common causes of COPD?
1. Chronic bronchitis
What PFT results are used to assess COPD?
An FEV1 less than what is defined as abnormal? FEV1/FVC?
FEV1 < 80%
Is it more high risk to be a gold miner or coal miner with regard to COPD?
In what age does the FEV1 start to decrease in non-smokers?
After 20 yo
How much faster does the FEV1 decline in smokers compared to non-smokers?
2-3 times faster
Which of the following is NOT attributed to speeding the progression of COPD?
a. Advanced age
d. Cor pulmonale
e. asthmatic bronchitis
Hypercapnia may speed the progression.
Which of the following is NOT a cause for COPD?
a. A1AT deficiency
b. Prolonged exposure to dusts (hog, grain, coal, gold)
c. 2nd hand smoke/Air pollution
d. Biomass energy sources
These have not been shown to cause it. (However, our lecturer says it's actually the 2nd most common cause.)
What percentage of smokers develop symptomatic COPD?
What condition is defined as "abnormal, permanent enlargement of the air spaces distal to the terminal bronchioles accompanied by tissue destruction"?
Is COPD considered an upper lobe or lower lobe disease?
Get more ventilation in the upper with more perfusion in the lower. (In normal patients.)
COPD is usually caused by a minimum of how many years of smoking?
10 years minimum
T/F: With COPD the patient will have maldistribution of perfusion with V/Q Mismatch.
False; Maldistribution of ventilation
What is the hallmark of established chronic bronchitis?
Enlargement of the mucus glands in the major bronchi.
What do bronchoscopic findings include with established chronic bronchitis?
3. Friability of tracheobronchial mucosa
What is Panlobular emphysema?
Involves the entire lung and produces uniform enlargement of all air spaces.
(Lobule = the smallest discrete portion of the lung surrounded by connective tissue septa)
What is Panacinar emphysema?
Panacinar emphysema destroys the entire alveolus uniformly and is predominant in the lower half of the lungs.
(Acinus = respiratory bronchiole with alveolar ducts and alveoli)
Which type of emphysema is most common with A1AT deficiency?
Which type of emphysema is most common in smokers?
Which 3 types of cells are found in increased numbers in the respiratory bronchioles of smokers?
2. Lymphcytes (CD8+)
According to the GOLD diagnostic criteria, an FEV1/FVC <0.7 and FEV1 greater than or equal to 80% is classified as what?
Stage 1 - Mild
According to the GOLD diagnostic criteria, an FEV1/FVC <0.7 and FEV1 greater than or equal to 50% but less than or equal to 80% is classified as what?
Stage 2 - Moderate
According to the GOLD diagnostic criteria, an FEV1/FVC <0.7 and FEV1 greater than or equal to 30% but less than or equal to 50% is classified as what?
Stage 3- Severe
According to the GOLD diagnostic criteria, an FEV1/FVC <0.7 and FEV1 < 30% is classified as what?
Stage 4 - Very severe
Aside from an FEV1 < 30%, the presence of what 2 other things meets the criteria for Stage 4 COPD?
Chronic respiratory failure OR Right heart failure
Which test is used to assess GOLD severity stages?
What are the 2 hallmarks of COPD?
1. Chronic cough
2. Persistent, progressive exercise limitation (b/c SOB)
What is the most common reason COPD patients seek medical help?
At what FEV1 percentage do patients typically begin to have COPD symptoms?
No symptoms until FEV1 is < 65%
At what FEV1 percentage do patients tend to get SOB with mild exertion?
Transient accumulation of mucus in the airways causes what symptom in COPD patients?
T/F: Chronic bronchitis has a productive cough
In what percentage of COPD patients is wheezing heard?
Emphysematous hyperinflation of the lungs may cause what 2 things on physical exam?
1. Hyperressonant percussion of chest
2. Low diaphragm
With more advanced COPD, what 2 findings would you expect on physical exam?
2. Prolonged expiratory phase
With COPD what do you expect to have happen to the FEV1/FVC ratio? TLC?
FEV1/FVC = Reduction
TLC = Increase
What is the best marker for assessing the severity of COPD?
Which test do you perform to confirm a COPD diagnosis, quantify the severity, and monitor the course of the disease?
What is the most common differential diagnosis of COPD?
What is the most important intervention for COPD?
What are 2 pharmacologic agents that are used to assist with smoking cessation?
What are 2 anti-cholinergic bronchodilators that are first line? (Per syllabus)
2. Tiotropium (Spireva)
What are Albuterol and Levoalbuterol?
What are Slameterol, Fomoterol, and Vilanterol?
What type of drug class is recognized as a more potent bronchodilator and used as an additive to beta-agonists?
What older medication is similar to caffeine?
Theophylline (it is an anti-inflammatory)
Which type of medicine is the most potent anti-inflammatory agent available?
Which medication type is said to decrease the number of exacerbations but not improve mortality?
What is the most commonly prescribed oral corticosteroid?
Which of the following is NOT an inhaled corticosteroid per our PPT?
Prednisolone is oral
In what type of patients are ICS most beneficial? (Per our speaker)
Patients with partially reversible obstruction on PFTs.
What side effect should you be concerned with for diabetes patients using oral corticosteroids?
Why should you put a COPD patient on a PPI or H2 blocker if you are treating them with corticosteroids?
To avoid the risk of GI bleeds, gastritis, or PUD
What is the most concerning side effect of corticosteroids per our speaker?
COPD patients taking birth control and using oral corticosteroids should be concerned about which side effect?
Mentrual abnormalities (and ineffectiveness of birth control)
What is the only treatment that has been shown to improve survival in hypoxic COPD patients?
What pharmacological combination MAY improve survival in COPD?
Combo of long-acting Beta-2-agonist and ICS
Per our speaker, what is the correct order of prescription of the following meds for the treatment of COPD exacerbation?
1st - Bronchodilators
2nd - Corticosteroids
Use Abx if patient has fever or purulent sputum
T/F: Pulmonary Rehabilitation improves pulmonary function and decreases total hospitalizations.
False; Rehab does not improve pulmonary function, but does decrease hospitalizations
If the patient has a poor response to bronchodilating anti-cholinergics (such as ipratropium), which medication should be added?
T/F: Good nutrition and weight loss are essential in the treatment of COPD.
Which pharmacologic agent is a PDE-4 inhibitor that results in higher FEV1 and lower exacerbation rates?
What are the 3 possible side effects of Roflumilast?
3. Weight loss
What type of medication should be prescribed to a patient with an acute episode of clinical worsening marked by increased SOB, excessive sputum production, and sputum purulence?
What 4 categories of antibiotics should be used with severe COPD?
1. Quinolone or Beta-lactam, Beta-lactamase inhibitor combination
3. Cephalosporin (oral; 2nd gen.)
4. Macrolide (2nd gen.)
What type of medication should be used to treat peripheral edema and may reduce pulmonary artery pressure?
Which ion should you avoid depleting with diuretics in COPD patients?
(It can depress respirations due to hypochloremic metabolic alkalosis.)
T/F: Vasodilators are an effective COPD treatment.
False; No evidence of sustained symtomatic and survival improvement
Exercise limitation, pulmonary HTN, right heart failure, and impaired CNS function is the result of what?
Chronic hypoxemia that causes secondary erythrocytosis.
In order to prevent chronic hypoxemia, what should be administered to patients?
Oxygen (Keeping SaO2 at 90%)
In order for oxygen to improve survival, how many hours per day should COPD patients use it?
24 hours per day.
At what PaO2 should oxygen be used? What about if it is in combination with peripheral edema, > 55% Hct, &/or P pulmonale on ECG?
- 55 mmHg or less
- 59 mmHg or less
Does the removal of emphysematous blebs have any survival advantage?
What are the expected P wave changes on an ECG with right ventricular hypertrophy?
Tall P wave (> 2.5 mm)
What are the expected R wave changes on an ECG with right ventricular hypertrophy? Which leads can you see this best in?
Tall R wave (> 6 mm)
Leads V1 and V2
In what leads would you expect to see a deep S wave on an ECG with right ventricular hypertrophy?
V5 or V6
(S wave is > 10 mm)
What axis deviation would you expect to see on an ECG with right ventricular hypertrophy?
Right axis deviation
(QRS axis +90 degrees to +180 degrees)