Term
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Definition
| Preventative & treatable disease w/some significant extrapulmonary effects that may contribute to the severity in individual patients. its pulmonary componenet is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive & associated w/an abnormal inflammatory response of the lung to noxious particles or gases. |
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Term
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Definition
| affects between 16-24 million people in the Us, 15-20% of smkoers develop COPD, 4th leading cause of death in the US, 2nd leading cause of disability |
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Term
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Definition
| CIGARETTE SMOKING!!! pipe, cigar, & enviromental tobacco smoke, pollution, occupational dusts & chemicals, underdeveloped lungs in gestation & childhood, genetic predisposition (deficiency of Alpha-1 antitrypsin) |
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Term
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Definition
| chronic inflammation processes in peripheral airways & lung parenchyma. inflammation mediators cause progressive changes in small airways & parenchyma that contribute to the obstruction |
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Term
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Definition
| COUGH, SPUTUM PRODUCTION, DYSPNEA ON EXERTION. Often precede development of airflow limitation by many years not all cough & sputum production will develop COPD. Episodes of acute worsening of these symptoms often occur (exacerbations) |
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Term
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Definition
| 3 hallmarks:cough, sputum, dyspnea + history of exposure to risk factor (tobacco smoke, occupational dust/chemicals, smoke from home cooking) |
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Term
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Definition
| I-Mild, airflow limitation w/w/out symptoms, II- Moderate worsening airflow limitation, SOB on exertion, III- Severe, more airflow limitation, greater SOB, reduced exercise capacity, repeated exacerbations, impact QOL, IV-Very severe, QOL impaired & exacerbations may be life threatening |
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Term
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Definition
| smoking cessation, relieve symptoms, prevent disease progression, improve exercise tolerance & health status, prevent & treat complications & exacerbations, reduce mortality, prevent & minimize side effects from treatment |
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Term
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Definition
1. assess & monitor disease
2. reduce risk factors
3. manage stable COPD
4. Manage exacerbations
periodic PFT's |
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Term
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Definition
| STOP SMOKING! cornerstone of therapy for preventing COPD. Lung health study confirm that smoking cessation slows the progression of COPD (reduces the rate of declince in lung function) |
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Term
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Definition
| pulmonary rehab: smoking cessation, exercise training, nutrition counseling, education |
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Term
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Definition
| improves intellectual functioning, minimizes memory loss & improves depressive sumptoms, nocturnal O2 increases quality of sleep, decreases arrhythmias, & improves daytime performance, shown to improve survival & quality of life if used 16-24 hr/day. |
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Term
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Definition
| bullectomy & lung transplants may be considered for some patients w/stage IV disease |
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Term
| anticholinergic Bronchodilators |
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Definition
| MOA- decrease cyclic GMP relaxing bronchial smooth muscle. >=bronchodilation of B2 agonists w/less systemic side effects, slower onset, longer duration. Not absorbed systemically |
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Term
| Adverse effects of anticholinergic Bronchodilators |
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Definition
A/E dry mouth & metalic taste
Short acting AC=Atrovent HFA (Ipratropium), Long acting AC= Tiotropium (Spiriva) |
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Term
| Short acting bronchodilator (AC) |
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Definition
| Atrovcent HFA (Ipratropium) 2 puffs qid (up to 12 inhalations/24hrs) available MDI & Neb, MDI peak 1.5-2hrs, duration 4-6hrs |
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Term
| Long acting bronchodilators (AC) |
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Definition
| Tiotropium (Sprivia) MAINTENCE THERAPY NOT ACUTE SYMPTOMS 18 mcg inhaled via DPI qd, peak 1.5-3 hrs, duration >=24 hrs, patients w/ CrCl <50 ml/min should be closely monitored |
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Term
| sympathomimetic Bronchodilators (B2A) |
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Definition
| MOA: stimluation of B2 receptors, increasing cAMP resulting in relaxation of bronchial smooth muscle, inhalation route is preferred for safety & efficacy, proper tech or use of spacer |
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Term
| A/E of sympathomimetic Bronchodilators (B2A) |
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Definition
| tachycardia, tremor, hypokalemia |
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Term
| short acting B-2 Agonist bronchodilator |
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Definition
| Albuterol (Proventil or Ventolin) 1-2 puffs q 4-6 hr prn, max 12 puffs/24hrs |
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Term
| Long actin B-2 agonist bronchodilators |
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Definition
| MAINTENANCE THERAPY NOT FOR ACUTE SYMPTOMS Salmeterol MDI (Serevent) 1 inhalation q12 hrs. FOrmoterol (Foradil) 12 mcg (1capsule) by DPI inhalation q12hrs, Arformoterol (Brovana) 15 mcg NEB q 12hrs |
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Term
| combo anticholinergic + sympathomimetics |
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Definition
| combining bronchodilators from different pharm classes may improve efficacy & decrease risk of S/E compared to increasing the dose of a single bronchodilator, fixed dose combo available-Combivent MDI (Ipratropium + Albuterol) 2 puffs qid |
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Term
| Methylxanthine bronchodilator Theophyline |
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Definition
| MOA: blocks phospiodiesterase increasing cAMP relaxing smooth muscle of bronchi & pulmonary vessels. Stimulates respiratory center & enhances ADLs w/severe COPD, may be helpful for nocturnal dyspnea. metabolized in liver, shorter half life in smokers, decrease dose for elderly, dose 1-2x daily, many drug/disease interactions, monitor closely |
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Term
| A/E Methylxanthine bronchodilator Theophyline |
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Definition
| restlessness, insomnia, gastroesophagel reflux during sleep, palpitations, potentiation of diuresis. |
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Term
| signs of toxic cAMP (Theophyline) |
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Definition
| >=20mg/L 75% patients experience advers reactions such as N, V, &D, H/A, insomnia, irritability. >= 35mg/L hyperglycemia, hypotension, atrial tachycardia, ventricular arrhythmias, refractory seizures |
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Term
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Definition
| regular treatment of inhaled corticosteroid only for FEV1<50% predicted & repeated exacerbations (3x/3yrs), treatment may relieve symptoms but not modify long term decline in FEV1, increases likelihood of pneumonia, long term use is not recommended causes HTN, elevations in blood glucose, long term use osteoporosis, depresses the immune system |
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Term
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Definition
| COPD patients are at increased risk for respiratory tract infections & developing serious complications if an infection occurs. Influenza vaccine-yearly Sept-Nov (reduces serious illness & death in COPD patients 50%). Pneumococcal vaccine- for >=65 COPD covers 85% of pneumococcal disease |
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Term
| Alpha 1 Antitypsin Augmentation therapy |
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Definition
| Young patients with severe hereditary alpha-1 antitrypsin deficiency & established emphysema may be candidates, refer to specialty practice that treats this |
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Term
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Definition
| not recommended except for treatment of infectious exacerbations & other bacterial infections, about 1/3 of infections are viral, bacterial caused microorganisms are S. pneumonia, H flu, M catarrhalis (all common respiratory pathogens) |
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Term
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Definition
| patients w.vicous sputum may benfit form mucolytics, but overall benefits are very small, use not recommended |
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Term
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Definition
| regular use contraindicated in stable COPD |
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Term
| therapeutic treatment MILD COPD |
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Definition
| active reduction of reisk factors:flu vaccine, add short acting brinchodilator prn |
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Term
| therapeutic recommendations for MODERATE COPD |
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Definition
| active reduction of reisk factors:flu vaccine, add short acting bronchodilator prn, add regular treatment w/1+ long-acting bronchodilators when needed add rehab |
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Term
| therapeutic recommendations for Severe III |
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Definition
| active reduction of reisk factors:flu vaccine, add short acting bronchodilator prn, add regular treatment w/1+ long-acting bronchodilators when needed add rehab, add inhaled glucocorticosteroids if repeated exacerbations |
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Term
| therapeutic recommendations very severe IV |
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Definition
| active reduction of reisk factors:flu vaccine, add short acting bronchodilator prn, add regular treatment w/1+ long-acting bronchodilators when needed add rehab, add inhaled glucocorticosteroids if repeated exacerbations, add long term oxygen if chronic respiratory failure, consider surgical treatments |
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Term
home management of COPD
bronchodilators |
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Definition
| increase dose &/or frequency of existing short acting bronchodilators tx, preferably w/B2 agonists, if not already used add anticholinergic until symptoms improve |
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Term
home management of COPD
corticosteroids |
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Definition
| if baseline FEV1<50 % predicted add 30-40 mg oral prednisone dq x7-10 days to bronchodilator regimen |
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Term
| home managment of COPD anitbiotics |
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Definition
| presence of 3 cardinal symptoms increased dyspnea, increased sputum volume, increase sputum purulence, increase sputum purulence +one other cardinal symptom, patients requiring mechanical ventilation |
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Term
| indications for hospital admission for exacerbations |
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Definition
| marked increase in intensity of sx, such as sudden development of resting dyspnea, severe background COPD, onset of new physical signs (cyanosis, peripheral edema), failure of exacerbation to respond to initial medical management, significant comorbidities, newly ocurring arrhythmias, frequent exacerbations, diagnostic uncertainty, older age, insufficient home support |
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Term
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Definition
| COPD is common, 4th leading cause of death 2nd leading cause of disability in US, cigarette smoking & air pollution are significant risk factors, aggressive non-pharmacologic & pharmacologic therapy may help preserve lung function, smoking cessation is key |
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