COPD packet 1

what are the gold guidelines for COPD?

global initiative for chronic obstructive lung disease

define COPD

• heterogeneous lung condition

• chronic respiratory symptoms (dyspnea, cough, sputum production)

• due to airway abnormalities (bronchitis) or alveoli abnormalities (emphysema)

• persistent, progressive airflow obstruction

acute bronchitis

• small airway inflammation

• airway swelling

• symptoms: cough, dyspnea

• causes: viruses (mainly), smoke, rarely bacteria

• can last a few weeks

chronic bronchitis

• inflammation of the airways (trachea, bronchi)

• leads to swelling and excessive mucus secretion

• chronic cough & sputum production most days >3 months/year for 2 consecutive years

• causes: mainly smoking

emphysema

• alveoli destruction (loss of gas exchange surfaces)

• alveoli lose elasticity, overstretch, and rupture

• symptoms: dyspnea, wheezing, cough

• cause: smoking (leading cause), infections/toxins

what are the main categories of risk factors for COPD?

• environmental

• genetics

• lung trajectories

environmental risk factors of COPD

• cigarette smoking

• secondhand smoking

• occupation exposures

• indoor/outdoor air pollution

• socioeconomic status

genetic risk factors of COPD

mainly alpha 1-antitripsyn deficiency (AATD)

lung trajectory risk factor of COPD

• poor lung growth (pneumonia at ages younger than 3, asthma, in utero nicotine exposure)

• infections (HIV, TB)

how long do lungs develop?

until ages 20-25

what are the cells that are involved in COPD?

macrophages, neutrophils, lymphocytes, epithelial cells

what does type 2 inflammation in copd target?

allergens via antibodies, eosinophils, interleukins

what are the steps in eosinophilic inflammation?

airway remodeling, mucus plugging, immune response dysregulation

what are some symptoms of copd?

• chronic dyspnea

• chronic cough

• sputum production

• wheezing

• chest tightness

• fatigue

what does spirometry consist of?

forced vital capacity & forced expiratory volume in 1 second

forced vital capacity

volume of air expired after complete inhalation

forced expiratory volume in 1 second

volume of air expelled in one second after maximum inhalation

what symptoms or risk factors that copd patients have?

• 20 pack-year of smoking

• recurrent chest infections

• early life events

what is the spirometry diagnosis?

FEV1/FVC < 70% (0.7)

when should spirometry be repeated?

on separate visit if ratio = 0.60-0.80

assessment of copd

symptoms → severity of airflow obstruction → exacerbation history/risks → blood eosinophils → comorbidity

how can copd symptoms be assessed?

• modified medical research council (mMRC)

• copd assessment test (CAAT)

• copd control questionnaire (CCQ)

• chronic respiratory questionnaire (CRQ)

mMRC

• self-administered

• only assesses dyspnea

• score 0-4

• choose highest true statement

• score greater than 2 shows increased symptoms

which self-assessment is preferred over mMRC?

CAT/CAAT

CAAT/CAT

• self-administration

• 8 questions (scale of 0-5)

• multiple symptoms are assessed

• total score greater than 10 shows increased symptoms

what are some physical exams to assess?

• patient appearance (SOB, respiratory distress, anxiety)

• use of accessory breathing muscles

• wheezing

what are some labs that can assess symptoms?

o2 saturation, decreased PaO2, increased PaCO2, increased Hct

mild classification

FEV1 >80

moderate classifcation

FEV1 50-80

severe classifcation

FEV1 30-50

very severe modification

FEV1 <30

what is the best predictor of frequent exacerbations?

history of exacerbations in the past year

what can predict the magnitude of ICS response in preventing exacerbations?

blood eosinophil count

what guides the use of ICS in management of COPD?

blood eosinophil count

what comorbidities can COPD increase?

risk of TB, lung cancer

what are common multimorbid states with copd?

CVD, metabolic syndrome, osteoporosis, depression, anxiety

what can copd impact?

hospitalizations and mortality

COPD: group A

• low risk, less symptoms

• mMRC < 2

• CAAT < 10

• no exacerbations in the past year

COPD: group B

• low risk, high symptoms

• mMRC >2

• CAAT >10

• no exacerbations in the past year

what elevates a patient from A or B to E?

if they have had an exacerbation in the past year

what are some additional assessments that a patient can have done?

• body plethysmography

• alpha-1 antitrypsin deficiency

• pulse ox

• exercise testing: 6 minute walk test

• chest CT

when is a chest CT recommended?

if 50-80 years old with 20 pack years smoking history to screen for lung cancer

BODE index for mortality risk

• B: bmi

• O: obstruction (FEV1)

• D: dyspnea (mMRC)

• E: exercise tolerance

what are some features on the COPD app?

• mMRC/CAT scores

• BODE calculator

• inhaler educational videos

• inhaler info

• treatment flowchart