NURS 620: Chronic Obstructive Pulmonary Disease (COPD) & Smoking Cessation

Vocabulary practice flashcards covering COPD definitions, pathogenesis, classifications, pharmacological management, and smoking cessation strategies based on NURS 620 lecture materials.

Chronic Obstructive Pulmonary Disease (COPD)

An irreversible condition that results in progressive obstruction of airflow and includes chronic bronchitis and emphysema.

Global initiative for Chronic Lung Disease (GOLD) definition of COPD

A preventable and treatable disease characterized by chronic airflow limitation that is not fully reversible.

Chronic obstructive bronchitis

A condition defined as partially reversible airflow limitation as well as the presence of chronic productive cough.

Emphysema

An abnormal permanent enlargement of the air space distal to the terminal bronchioles.

FEV1 decrease in normal physiologic aging

$$30\,\text{cc/year}$$

FEV1 loss in COPD patients

$$80\,\text{cc/year}$$

Functional capacity loss threshold

Disabling signs and symptoms of COPD usually do not appear until $50\%$ to $70\%$ of lung function is lost.

Work of breathing in COPD

$10$ to $20$ times greater than a normal person.

Pathophysiology of Emphysema

Destruction of the alveolar septa and enlargement of air spaces; T lymphocytes, eosinophils, and mast cells promote tissue destruction, reducing elastic recoil.

Pathophysiology of Chronic Bronchitis

Prolonged exposure to bronchial irritants (tobacco) resulting in goblet cell hyperplasia leading to mucus hypersecretion.

Common Clinical Features of COPD

Chronic cough, dyspnea, current/previous tobacco use, chronic sputum production, and history of dust/chemical exposure.

Objective Presentation - COPD

Barrel Chest, diminished breath sounds, prolonged expiratory phase, and expiratory wheezing.

COPD Exacerbation Physical Signs

Inspiratory and expiratory wheezing and coarse crackles.

Late Findings of COPD

Neck vein distention, lower extremity edema, clubbing of fingernails, and changes in mental status.

Alpha1-antitrypsin (AAT) deficiency indications

Emphysema onset younger than $45$ years old, emphysema in non-smokers, basilar hyperlucency, unexplained liver disease, necrotizing panniculitis, or positive family history.

Oxygen Therapy Goal

Maintenance of oxygen saturation at $90\%$ or better.

Mild COPD (GOLD Category)

$FEV_1 \ge 80\%$ predicted; no abnormal signs, cough (+/- sputum), little/no dyspnea.

Moderate COPD (GOLD Category)

$50\% \le FEV_1 < 80\%$ predicted; breathlessness, cough, variable abnormal signs, possible hypoxemia.

Severe COPD (GOLD Category)

$30\% \le FEV_1 < 50\%$ predicted; dyspnea with any exertion or rest, prominent wheeze and cough.

Very Severe COPD (GOLD Category)

$FEV_1 < 30\%$ predicted; lung hyperinflation, cyanosis, peripheral edema, polycythemia, hypoxemia and hypercapnia common.

Beta 2 Agonists - Short Acting (SABA)

Albuterol/Ventolin, Levalbuterol/Xopenex; used for bronchospasm, should avoid MAO inhibitors/tricyclic antidepressants within $14$ days.

Beta 2 Agonists - Long Acting (LABA)

Salmeterol/Serevent, Formoterol/Perforomist; preferred maintenance medication, not for acute rescue.

Antimuscarinics - Short-Acting (SAMA)

Ipratropium/Atrovent; long term bronchodilator maintenance med.

Antimuscarinics - Long-Acting (LAMA)

Tiotropium/Spiriva, Aclidinium bromide/Tudorza; long term maintenance, not for acute bronchospasm.

Methylxanthine (Theophylline)

Nonspecific phosphodiesterase inhibitor with a narrow therapeutic window; side effects include arrhythmias, anxiety, and lowered seizure threshold.

Phosphodiesterase-4 (PDE4) Inhibitors

Roflumilast/Daliresp ($550\,\text{mcg}$ daily); reduces exacerbation risk in patients with severe COPD and history of exacerbations.

Common Pathogens in COPD Exacerbation

S. pneumoniae, H. influenzae, and M. catarrhalis; risk of Pseudomonas aeruginosa must also be considered.

Standard Antibiotic Regimens for COPD Exacerbation

Doxycycline $100\,\text{mg}$ Q 12hrs, Trimethoprim-sulfamethoxazole $160/800\,\text{mg}$ Q 12hrs, or Azithromycin ($500\,\text{mg}$ day 1 then $250\,\text{mg}$ QD).

The 4 Rs of Smoking Cessation Advice

Risks of smoking, Relevance to symptoms, Rewards of cessation, and Repeat as needed.

The 5 As of Tobacco Management

Ask (record smoking status), Advise (clear, strong advice), Assess (motivation), Assist (provide materials/meds), and Arrange (follow-up within $1$ to $2$ weeks).

Follow-up schedule for COPD

Severe/Unstable every month; Stable yearly; Theophylline levels every 6 months; Home Oxygen ABGs semiannually.