Chapter 13

COPD

Chronic Obstructive Pulmonary Disease; a treatable disease characterized by airflow limitation that is not fully reversible.

Chronic Bronchitis

A type of COPD

characterized by a chronic productive cough for 3 months in each of two successive years, excluding other causes.

Emphysema

A type of COPD

marked by the permanent enlargement of air spaces distal to the terminal bronchioles, accompanied by destruction of their walls.

Spirometry

A common test used to assess lung function, including measuring FVC, FEV1, and FEV1/FVC ratio for diagnosing COPD.

BODE Index

A scoring system used to predict the risk of mortality in COPD patients, based on Body mass index, Obstruction, Dyspnea, and Exercise capacity.

Hypoxemia

A deficiency in the amount of oxygen reaching the tissues, often associated with chronic bronchitis and emphysema.

Exacerbation Assessment

A measure in COPD management to evaluate the risk and presence of exacerbations, guiding therapy adjustment.

Alveolar-Capillary Membrane

The membrane where gas exchange occurs; destruction in emphysema leads to impaired gas exchange.

Peak Expiratory Flow Rate (PEFR)

A measure of how fast a person can exhale, used to monitor airway obstruction in COPD patients.

Chronic Ventilatory Failure

A condition characterized by an inability to maintain adequate ventilation, often noted in severe COPD.

WHAT IS ASSOCIATED WITH COPD

ABNORMAL INFLAMMATION RESPONSE OF THE LUNGS TO NOXIOUS PARTICLES OR GASES

AND PROGRESSIVESI

IS COPD PREVENTABLE AND TREATABLE

Yes, COPD is preventable and treatable through lifestyle changes, medications, and pulmonary rehabilitation.

DOES COPD ONLY IMPACT THE LUNGS

YES PRIMARILY BUT HAS SYSTEMIC AFFECTS

TO BE DX WITH CHRONIC BRONCHITIS HOW LONG MUST A COUGH EXIST

For at least three months in two consecutive years.

WHAT ARE MARKERS FOR EMPYSEMA

PERMAMENT ENLARGEMENT OF THE AIR SPACES DISTAL TO THE TERMINAL BRONCHIOLES, accompanied by destruction of the alveolar walls.

ATS STATES CHRONIC BRONCHITIS IS BASED ON

THE MAJOR CLINICAL MANIFESTATIONS ASSOCIATED WITH THE DISEASE

PERSISTENT COUGH AND MUCUS PRODUCTION

WHAT DOES ATS STATE EMPYSEMA IS BASED ON

PATHOLOGY

DAMAGE TO ALVEOLI (AIR SACS)

PTS WITH COPD TYPICALLY ASLO HAVE

CHRONIC BRONCHITIS AND EMPHYSEMA

ANATOMIC ALTERATIONS OF THE LUNGS ASSOCIATED WITH CHRONIC BRONCHITIS

CHRONIC INFLAMMATION

THICKENING OF THE WALLS OF THE PERIPHERAL AIRWAYS

EXCESSIVE MUCUS PRODUCTION AND ACCUMULATION

PARTIAL OR TOTAL MUCUS PLUGGING OF THE AIRWAYS

SMOOTH MUSCLE CONSTRICTION OF BRINCHIAL AIRWAYS (BRONCHOSPASM)

AIR TRAPPING AND HYOERUINFLATION OF THE ALVEOLI

ANATOMIC ALTERATIONS OF THE LUNGS ASSOCIATED WITH EMPHYSEMA

PERMANENT ENLARGEMENT AND DESTRUCTION OF THE AIR SPACES DISTAL TO THE TERMINAL BRONCHIOLES

DESTRUCTION OF THE ALVEOLAR -CAPILLARY MEMBRANCE

WEAKENING OF THE DISTAL AIRWAYS (PRIMARILY THE RESPIRATORY BRONCHIOLES)

AIR TRAPPING AND HYPERINFLATION

WHAT IS THE AMOUNT OF PEOPLE THAT HAVE EITHER CHRONIC BRONCHITIS, EMPHYSEMA OR COMBINATION

10 -15 MILLIONAMERICANS HAVE COPD

RISK FACTORS ACCORDING TO GOLD

GENETIC PRE-DISPOSITION

AGE & GENDER

CONDITIONS THAT AFFECT NORMAL LUNG GROWTH

EXPOSURE TO PARTICLES

SOCIOECONOMIC STATUS

ASTHMA/BRONCHIAL HYPER-SENSITIVITY

CHRIONIC BRONCHITIS

RESP INFECTIONS

TB

KEY INDICATORS FOR CONSIDERING COPD IN PTS OVER 40

DYSPNEA

CHRONIC COUGH

CHRONIC SPUTUM PRODUCTION

HX OF EXPOSURE AND RISK FACTORS

FAMILY HX OF COPD

WHAT ARE THE 3 MAIN SPIROMETRY TESTS

FVC

FEV1

FEV1/FVC RATIIO

PEAK EXPIRATORY FLOW

WHAT ARE THE CARIOPULMONARY SIGNS ASSOCIATED WUTH CHRONIC BRINCHITIS + EMPHYSEMA (COPD)

EXCESSIVE BRINCHIAL SECRETIONS

BRONCHOSPASMS

DISTAL AIRWAY AND ALVEOLAR WEAKENING

HOW DO LUNG CAPACITIES LOOK IN A PFT ASSOCIATED WITH COPD

VT NORMAL OR INCREASED

RV normal or decreased

ERV. normal or decreased

VC. DECREASED

IC. DECREASED

FRC. INCREASED

TLC. NORMAL OR INCREASED

RV/TLC. NORMAL OR INCREASSED

WHAT ARE THE FORCED EXP VOLUME AND FLOW RATE FINDINGS

FVC DE CREASED

FEV 1 DECREASED

FEV1/FVC RATIO DECREASED

FEF 25-75%. DECREASED

FEF50%. DECREASED

FEF200-1200. DECREASED

PEFR DECREASED

MVV. DECREASED

CHEST ASSESMENT FINDING S

PALPATION FOR EMPHYSEMA

DECERASED TACTILE FREMITUS

DECREASED CHEST EXPANSION

PMI DISPLACED LATERALLY

AUSCULATION SOUNDS FOR CHEST FINDINGS FOR EMPHYSEMA

DIMINISHED BREATH SOUNDS

PROLONGED EXPIRATION

DIMINSIHED HEART SOUNDS

WHAT WILL THE PERCUSSION SOUND BE FOR EMYSEMA

HYPERRESONANT

DECREASED DIAPHRAGMATIC EXCLUSIONS

HOW IS PALPATION CHEST FINDINGS FOR CHRINIC BRONCHITIS

NORMAL

HOW IS THE AUSCULATAION FOR CHRINIC BRONCHITIS

CRACKLES OR WHEEZE

WHAT DOES THE PERCUSSION OF THE CHEST FOR CHRONIC BRONCHITIS

NORMAL

WHAT IS A CLASSIC DIAGNOSTIC TOOL TO DETERMINE IF EMPYSEMA

DLCO

(diffusing capacity of the lungs for carbon monoxide) is used to assess gas exchange efficiency in the lungs, particularly in conditions like emphysema.

ABG FOR CHRONIC BRONCHOTIS AND EMPHYSEMA

PH - NORMAL

PACO2 ELEVATED

BICARB - ELEVANTED

PAO2 - DECREASED

SAO2/SPO2 - DECREASED

HGB/HCT FOR EMPHYSEMA

NORMAL - MILD TO MODERATE

ELEVATED -LATE STAGE

ELECTROLYTES FOR EMPYSEMA

HYPERCHLOREEMIA - WHEN VENT FAILURE IS PRESENT

HYPERNATREMIA - NA+

SPUTUM EXAM FOR EMPHYSEMA

NORMAL

CXR FOR EMPHYSEMA

TRANSLUCENT

DEPRESSED/FLATTENDED DIAPHRAGM

LONG AND NARROW HEART

INCREASED RETROSTERNAL ARISPACE

AND HYPERINFLATION

HGB/HCT FOR CHRINIC BRONCHITIS

Polycythemia due to chronic hypoxia.

ELECTROLYTES FOR CHRONIC BRONCHITIS

HYPOCHLOREMEIA - WHEN CHRONIC VENT FAILURE IS PRESENT

HYPERNATREMIA

SPUTUM EXAM FOR CHRONIC BRONCHITIS

STREPTOCOCCUS PNEUMONIAE

HAEMOPHILUS INFLUENZAE

MOXELLUS CATARRHALIS

CXR FOR CHRONIC BRONCHITIS

LUNGS MAY BE CLEAR ONLY IF LARGE BRONCHI EFFECTED

OCCASIONALLY TRANSLUCENT

DEPRESSED/FLATTENED DIAGRAGRAMDOME OF THE DIAPHRAGM

HOW DOES A BRONCHOGRAM LOOK FOR CHRONIC BRONCHITIS

SPIKE LIKE PROTRUSIONS

HOW MANY GRADES ARE THERE FOR GOLD BASED ON SEVERITY

4

GRADE 1, 2, 3, AND 4

WHAT IS GRADE 1

MILD

FEV1 80% predicted

WHAT IS GRADE 2

MODERATE

FEV1 50 AND LESS THAN 80% predicted

WHAT IS GRADE 3

SEVERE

FEV1 30 AND LESS THAN 50% predicted

WHAT IS GRADE 4

VERY SEVERE

FEV1 LESS THAN 30% predicted

GROUP A FROM GOLD 2025, WHAT IDENTIFIES PT WITHIN GROUP A

Patients at low risk with less symptoms, characterized by a mMRC dyspnea scale score of 0-1 and a low exacerbation history.

GROUP A FROM GOLD 2025, WHAT IDENTIFIES PT WITHIN GROUP B

Patients at high risk with more symptoms, characterized by a mMRC dyspnea scale score of 2 or more and a higher exacerbation history.

ROUP A FROM GOLD 2025, WHAT IDENTIFIES PT WITHIN GROUP E

PTS EXACERBATIONS OR GREATER THAN 1 TO HOSPITALIZATIONS

WHAT IS INITIAL TX FOR GROUP A

BRONCHODILATOR

SABA/LABA PRN

WHAT IS THE INITIAL TX FOR GROUP B

LABA + LAMA MAINTENANCE

SABA PRN

GROUP E, WHAT IS THE INTIAL TX

LABA + LAMA

ACCESS FOR ICS AND SABA PRN

CONSIDER LABA + LAMA + ICS IF BLOOD EOSINOPHILS IS GREATER THAN 300

FOR COPD, WHAT ARE ITEMS WE ASSESS FOR (THERAPIES)

O2 THERAPY

VACCINES

PDE 4 INHIBITORS

ANTIBOTICS

MUCOLYTICS

MONOCLONAL (IF INCREASED BLOOD SERUM EOSINOPHILS)

NICTOTINE REPLACEMENT

ALPHA 1 ANITTRYPSIN REPLACEMENT THERAPY

LOW DOSE OPOIDS FOR DYSPNEA RELIEF

PULM HYPERTENSION THERAPY

WHAT ARE SURGUCAL RECOMMENDATIONS FOR COPD

ASSESS FOR LUNG VOL REDUCTION THERAPY

ASSESSNFOR BULLECTOMY

CONSIDER LUNG TRANSPLANTATION

LARGE AIRWAY STENTING

COILING

ENDOBRONCHIAL VALVE THERAPY

WHAT ARE COPD MANAGEMENT THERAPIES

ASSESS SMOKING SESSATION

ASSESS PULM REHAB

PT EDUCATION ON MEDS (HOW, WHY, AND WHEN)

TRIGGERS

PT (TO MAINATIN ADLS)

MANAGE COMORBIDITIES AND COMORBIDITIES

PALLIATIVE CARE CONSULT

PUSED LIP BREATHING

DEEP BREATHING AND COUGH

INCENTIVE SPIROMETER (10X/HOUR)

WHAT ARE TEH TESTS FOR COPD

PFT

DLCO

CXR (ACUTE AND BASELINE)

ABG (ACUTE AND BESELINE)

CBC WITH FIFFERENTIAL

SPUTUM CULTURE AND STAIN

ALPHA 1 ANTI TRPSIN DEF

WHAT ARE NUTRITION RECOMMENDATIONS FOR COPD

HTDRATION

DECREASE CARBS

HIGH PROTIEN

INCREASE ANTI-OXIDANTS

CARDIAC DIET (IF CARDIAC ISSUES PRESENT)

INCREASE VITAMINS (D,C,E) AND POTASSIUM AND

WHAT ARE INTERVENTIONS FOR COPD

SABA 1-2 DOSES (ADD SAMA)

IV STEROIDS

O2 THERAPY (NASAL CANNULA OR HFNC AS NEEDED)

NIV - ASSESS AS 1ST CHOICE IF IN VENTILATORY FAILURE

MECH VENT - IF NIV FAILED

CONTINOUS ALBUTEROL IF NEEDED (5-20 MG/HR)

ANTIBIOTICS -IF THERE IS A SIGN OF BACTERIAL INFECTION

WHAT FUNCTION IS DIMINSHED IN COPD

CILIARY FUNCTION

WHAT ARE EXAMPLES FOR INDOOR POLLUTANTS

WOOD

ANIMAL DANDER

BLOWMASS IN COOKING

WHAT GENDER IS OFTEN PLAQUED WITH COPD

MALES

WHAT IS DYSANPSIS

A condition characterized by impaired communication and coordination between the brain and the respiratory muscles, often resulting in difficulty breathing.

ABBREVIATIONS

QD

TID

QID

Q6H

QD -EVERY DAY

TID -3X A DAY

QID -4X A DAY

Q6H - EVERY 6 HOUR

WHAT ARE THE DIFFERENT FREQUENCIES ASSOCIATED WITH COPD

EXACERBATION

SYMPTOM

MEDICATION

O2 THERAPY

NAME THE SYMPOTOMS AND EXACERBATIOS. FOR EACH GROUP

GROUP A - LOW SYMPTOMS/LOW EXACERBATIIONS

GROUP B - HIGH SYMPTOMS/LOW EXACERBATIONS

GROUP E - HIGH SYMPTOMS/HIGH EXACERBATIONS

WHAT IS MAINATENCANCE THERAPY

A treatment regimen aimed at managing chronic conditions, focusing on reducing symptoms and preventing exacerbations.

PINK PUFFER

A term used to describe patients with emphysema who often present with a thin appearance, pursed lips, and difficulty breathing, typically characterized by increased respiratory rate and diminished breath sounds.

BLUE BLOATER

A term used to describe patients with chronic bronchitis who often exhibit symptoms like a productive cough, obesity, and cyanosis, with decreased respiratory rate and often normal or increased breath sounds.

WHAT IS THE BODY BUILD FOR EMOYSEMA PT

THIN

BARREL CHEST

WHAT IS BODY BUILD FOR BRONCHITUES

STOCKY AND OVERWIEIGHT

CHEST DIAMETER IS NORMAL

WHAT IS THE BREATHING PATTERN FOR EMPHYSEMA PT

HYPERVENTILATION AND MARKED DYSPNEA OFTEN OCCURS AT RESTwith prolonged expiratory phase and a decreased respiratory rate.

WHAT IS RESPIRATORY PATTERN FOR PT WITH BRINCHITIS

DIMINSIHED RESP DRIVE

HYPOVENTILATION WITH RESULTANT HYPOXIA AND HYPERCAPNIA

WHICH HAS PUSED LIPPED BREATHING EMPYSEMA OR BRONCHITIS

EMPYSEMA

WHICH HAS A CLASSIC COUGH EMPYSEMA OR BRINCHITUS

BRONCHITIS

WHICH HAS SPUTUM EMPOYSEMA OR BRONCHITUS

BRONCHITIS, characterized by productive cough producing sputum, often colored.

WHICH IS PRONE TO CYANOSIS

BRONCHITIS

TYPE A COPD IS WHAT

EMPYSEMA

TYPE B COPD IS WHAT

BRONCHITIS, characterized by chronic productive cough and airflow obstruction.

PERIPHERAL EDEMA IS IT COMMON FOR EMPYSEMA OR BRONCHITIS

Bronchitis, often resulting from increased pressure in the pulmonary circulation.

WHICH USES ACCESSORY MUSCLES EMPYSEMA OR BRONCHITIS

Emphysema uses accessory muscles for breathing due to increased work of breathing.

WHICH HAS POLYCYTHERMIA EMPHYSEMA OR BRONCHITIS

Bronchitis often leads to polycythemia due to chronic hypoxia, causing the body to produce more red blood cells.

WHICH HAS A DECREASED DLCO EMPYSEMA OR BRONCHITIS

EMPYSEMA

WHICH IS MORE PRONE TO PULM HYPERTENSION EMPYSEMA OR BRONCHITIS

Bronchitis is more prone to pulmonary hypertension due to chronic airflow limitation and increased vascular resistance.

WHICH IS COR PULMONALE MORE COMMON EMPHYSEMA OR BRONCHITIS

BRONCHITIS