Understanding COPD: Definitions and Diagnoses

A comprehensive set of QA flashcards covering COPD definitions, pathophysiology (bronchitis vs emphysema), diagnosis (spirometry, DLCO, imaging), GOLD staging and grouping, asthma-COPD considerations, management strategies, screening, and pediatric cough considerations from the provided lecture notes.

What is COPD according to GOLD?

A heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, sputum, exacerbations) due to abnormalities of the airway (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction.

What are the two main conditions COPD describes?

Chronic bronchitis and emphysema.

Chronic bronchitis is defined as what?

A chronic productive cough for at least three months in each of two successive years, after excluding other causes; may precede or follow development of airflow limitation.

Emphysema is characterized by what pathological change?

Enlargement of airspaces distal to the terminal bronchioles with destruction of airspace walls, often with dyspnea and hyperinflation; may occur with or without airflow obstruction.

What test is essential to confirm COPD diagnosis?

Spirometry, ideally with a post-bronchodilator assessment.

What post-bronchodilator FEV1/FVC ratio supports a COPD diagnosis?

Less than 0.70 (or below the lower limit of normal).

GOLD 1 (Mild) COPD criteria by FEV1 % predicted?

FEV1 ≥ 80% predicted.

GOLD 2 (Moderate) COPD criteria by FEV1 % predicted?

FEV1 50–79% of predicted.

GOLD 3 (Severe) COPD criteria by FEV1 % predicted?

FEV1 30–49% of predicted.

GOLD 4 (Very severe) COPD criteria by FEV1 % predicted?

FEV1 < 30% of predicted.

What factors determine GOLD Group A vs B vs C vs D categorization?

Symptom burden (MMRC or CAT) and risk of exacerbations (past-year exacerbations and hospitalizations), with airflow limitation (FEV1) informing severity. eosinophil considerations and hospitalization history may influence therapy choices.

Which tools measure symptoms for GOLD categorization?

MMRC dyspnea scale or CAT (COPD Assessment Test).

Which vaccinations are generally recommended for all COPD patients?

Influenza, pneumococcal, and COVID-19 vaccinations.

What are potential manifestations of pre-COPD?

Symptoms such as chronic bronchitis or dyspnea; DLCO

What are the three key requirements for diagnosing COPD?

Presence of pulmonary symptoms (dyspnea, cough, sputum), risk factors (eg, tobacco exposure), and evidence of airflow limitation on spirometry (post-BD FEV1/FVC <0.70).

What is DLCO used for in COPD evaluation?

DLCO helps establish the presence of emphysema but is not necessary for routine COPD diagnosis.

What is the hallmark spirometry finding for COPD?

Post-bronchodilator FEV1/FVC ratio < 0.70 indicating persistent airflow limitation.

How does COPD differ from asthma in terms of reversibility?

COPD typically has partial or no reversibility of airflow limitation after bronchodilators; asthma shows reversibility and more variability in airflow obstruction.

What is ACO in respiratory medicine?

Asthma-COPD Overlap; an overlap phenotype where patients have features of both asthma and COPD; definitions and criteria remain controversial.

What is the first-line long-acting bronchodilator for COPD?

LAMA (long-acting muscarinic antagonist).

What role does ICS play in COPD and asthma?

ICS is essential for asthma control and is used in COPD for patients with frequent exacerbations or elevated eosinophils; it is not typically used as monotherapy in COPD.

What is triple therapy in COPD?

ICS/LABA/LAMA combination therapy for patients with persistent symptoms or frequent exacerbations despite dual therapy.

What is SABA used for in COPD/asthma management?

Short-acting beta2-agonist; reliever therapy for acute symptoms.

What are key components in managing COPD exacerbations?

Short-acting systemic corticosteroids and antibiotics when indicated; supplemental oxygen; pulmonary rehabilitation; criteria for hospitalization include severe symptoms, hypoxemia, hypercapnia, or major comorbidities.

Who should be offered LDCT lung cancer screening according to USPSTF?

Adults aged 50–80 years with a 20+ pack-year smoking history who currently smoke or have quit within the past 15 years.

What does CAPTURE stand for?

COPD Assessment in Primary care To identify Undiagnosed Respiratory disease and Exacerbation risk.

What are common acute etiologies of pediatric cough?

Viral upper respiratory infections, bronchiolitis/RSV, croup, pertussis, and acute asthma/reactive airway disease.

What is Downe's scoring system used for?

Assessment of respiratory distress in infants; higher scores indicate greater distress.

What red flags in cough warrant urgent pulmonary referral?

Hemoptysis, unexplained weight loss, persistent fever, significant or progressive dyspnea, chest pain, hypoxemia, or abnormal lung exam.

What are common adult acute cough etiologies listed in the notes?

Viral URI (antibiotics not indicated for uncomplicated cases), COVID-19/flu, acute bronchitis, post-nasal drip, asthma (including cough-variant), GERD, COPD, and ACE-inhibitor–induced cough.

What do pediatric exam findings like cobblestoning in the nasal mucosa suggest?

Allergic/inflammatory changes; often seen with rhinitis or sinusitis contributing to cough.

What imaging signs on chest radiograph suggest severe emphysema?

Hyperinflation (enlarged lungs, flattened diaphragm, increased AP diameter) and loss of parenchymal markings; large bullae may be present.