COPD Thill

wasabi's version from 2015-10-14 19:02

Section 1

Question Answer
severe COPD can causeright HF
how many adults have COPD20%
diagnosis for COPDspirometry, cough, progressive dysypnea, sputum prod,
spirometry for COPD comparesFEV1/FVC ratio. air exhaled during the first second divided by max volume of air forcibly exhaled
spirometry repeated3 times pre and post bronchodilator. test with greatest sum reported
COPD versus asthma how tell by spirometry?post broncho increase by FEV1 or FVC increases by more than 12% and 200 ml more asthma. post broncho FEV1/FVC less than 70% confirms COPD
Stage 1 COPDFEV1/FVC less than 70. FEV1 more than or equal to 80% predicted
Stage 2 COPDFEV1/FVC less than 70. FEV1 under 80 but equal to or more than 50
how stage COPD?post broncho FEv1
Stage 3 COPD30-50% of predicted
Stage 4 COPDless than 30% of predicted or less than 50% with chronic resp failure
Stage 1 COPD symptomsmay or may not have symptoms. chronic cough and sputum
Stage 2 COPD symptomsusually seek med attn cuz sypmtoms or exacerbation
stage 3 COPD symptomsgreater SOB, reduced exercise capacity, fatigue, repeated exacerbations that usually impact quality lfie
stage 4 COPD sumptomsQOL sig impaired, exacerbations may be life threatening

Section 2

Question Answer
mild COPD =stage 1. avoidance of risk factors. stop smoking. SABA-albuterol, atrovent (ipratropium), or both
moderate COPD=stage 2. SABA, LABA with or without ICS or LAMA
severe COPD=stage 3. add ICS if repeated exacerbations
very severe COPD=stage 4. add long term oxygen if chronic resp failure. consider surgical treatments
albuterol MOAstimulate beta 2 receptors relax smooth muscle. onset 5 to 15 mins 4-6 hours duration
ipratropium MOAblocks Ach at bronchial smooth muscle receptors to cause dilation. onset 15-20 mins duration 6-8 hours
stage 2 moderate COPD is LAMA or LABA better?LAMA better
theophylline used?rarely in COPD. due to DDIs and adverse events
theophylline dose100 bid and titrate up
side effects theophyllineGI, tachycardia, arrthmia, HA, insomnia, seizures
drug interactions theocyp 1A2
Roflumilast- Daliresp used whenstage 3 or 4. rarely used. PDE4 inhibitor (inflamm cells). 500 mcg daily.
daliresp side effectsnausea, headache, insomnia, suicidality
drug interactionscyp 1a2 and 3a4
pharm therapies no work?mucolytic, antitussives
narcoticsfor end of life
prednisonenot recc