Term
| Chronic Obstructive Pulmonary Disease (COPD) |
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Definition
chronic disease of the airways characterized by airflow limitation that is progressive and NOT FULLY REVERSIBLE;
associated with abnormal inflammatory response to noxious particles or gases; |
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Term
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Definition
Cigarette Smoke;
Occupational dusts & chemicals: organic & inorganic dusts, chemical agents, & fumes, indoor air pollution;
Host Factors:
- alpha-1-antitrypsin (AAT) deficiency;
- airway hyperresponsiveness;
insufficient lung growth (low birth weight, prematurity, or childhood illness) |
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Term
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Definition
cough, dyspnea, sputum production, hx of exposure to risk factors;
often present for several years before dyspnea develops; |
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Term
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Definition
normal PhEX in milder stages;
As it progresses & airflow limitation worsens:
- cyanosis of mucosal membranes, "barrel chest", increased respiratory rate, shallow breathing, changes in breathing mechanics ("pursed lips") |
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Term
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Definition
FEV1/FVC ration <70% --> airway obstruction;
Post-bronchodilator FEV1 <80% predicted confirms presence of airflow limitation that is NOT FULLY REVERSIBLE |
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Term
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Definition
most important prognostic indicator;
Avg. rate of decline is MOST USEFUL to assess course of COPD;
Rapid decline in this along with other tests indicates a poor prognosis; |
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Term
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Definition
FEV1/FEV <70%;
FEV1 >=80% predicted;
Treatment:
Active reduction of risk factors, give influenza vaccine;
ADD SA bronchodilator (SABA, SAAC) when needed;
Chronic symptoms may/may not be present; |
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Term
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Definition
FEV1/FVC <70%;
50% <= FEV1 <80% predicted;
Treatment:
Active reduction of risk factors, give influenza vaccine;
Add SA bronchodilator (SABA, SAAC) when needed;
ADD regular tx w/ 1 or more LA bronchodilator PRN; Add rehabilitation;
Chronic Sx may/may not be present; |
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Term
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Definition
FEV1/FVC <70%;
30% <= FEV1 < 80% predicted;
Treatment:
Active reduction in risk factors, influenza vaccination;
ADD SA bronchodilator PRN;
ADD ICS if repeated exacerbations (3 in 3 yrs)
Chronic symptoms may/may not be present; |
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Term
| Stage IV Very Severe COPD |
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Definition
FEV1/FVC <70%;
FEV1 <30% predicted OR FEV1 <50% predicted plus respiratory failure (PaO2 <60 mmHg, PaCO2 >50 mmHg)
Treatment:
Active reduction of risk factors, influenza vaccination;
ADD SA bronchodilator PRN;
ADD ICS if repeated exacerbations;
ADD long-term O2 therapy if chronic respiratory failure;
Consider surgical treatments; |
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Term
| Desired Outcomes of COPD Treatment |
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Definition
Major focus: PREVENTION;
Primary goal: minimize progression of dx;
Many therapies reduce exacerbations & improve QOL but NOT survival or slow lung fcn decline; |
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Term
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Definition
prevent dx progression;
relieve sx;
improve exercise tolerance;
improve overall health status;
prevent & treat exacerbations;
prevent & treat complications;
reduce morbidity & mortality;
achieve max pharmacotherapeutic benefit w/ minimal side effects; |
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Term
| 4 Primary Components of COPD Management |
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Definition
Assess & monitor condition;
Avoid or reduce exposure to risk factors;
Manage stable dx;
Treat exacerbations; |
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Term
| Non-Pharmacological Therapy for COPD |
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Definition
Educate pts about disease, tx plans, & strategies to slow progression & prevent complications;
SMOKING CESSATION!!!
Pulmonary Rehabilitation - improves exercise tolerance, reduces sx of dyspnea & fatigue (exercise training, breathing exercises, optimal med tx, psychosocial support, health ed);
Immunizations: inactivated influenza (annually), PPSV (pnuemococcal, 1x for pts 2-64 yrs of age w/ chronic lung dx & ALL adults >65 yrs);
Long-term O2 therapy: increases survival in pts w/ chronic hypoxemia, use if resting PaO2 <55 mmHg or if evidence of right-sided HF, polycythemia, or impaired neuropsychiatric fcn w/ PaO2 <60 mmHg;
Goal: to raise PaO2 >60 mmHg |
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Term
| Clinical Effects of Bronchodilators |
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Definition
increased exercise capacity;
decreased air trapping;
relief of symptoms; |
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Term
| Short-Acting Beta-2-Agonists - albuterol (Proventil, Ventolin, ProAir, Accuneb) |
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Definition
MDI & Nebulized soln;
NOT approved for COPD by FDA;
Duration of Action: 4-6 hrs;
Place in COPD Therapy:
- Initial therapy for pts w/ intermittent sx
Equivlant to short-acting anticholinergics; |
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Term
| Long-Acting Beta-2-Agonists - salmeterol (Serevent), formoterol (Foradil, Perforomist), arformoterol (Brovana) |
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Definition
DPIs, Nebulized solns;
Duration of Action:
- 12 hrs;
Place in Therapy:
- Pts w/ moderate to severe COPD w/ regular sx or in whom short-acting therapies do not provide adequate relief; |
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Term
| Short-Acting Anticholinergics - ipratropium (Atrovent) |
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Definition
MDI, Nebulized soln;
Duration of Action: 4-6 hrs;
Place in Therapy:
- initial therapy for pts w/ intermittent symptoms;
Equivalent efficacy to SABAs |
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Term
| Long-Acting Anticholinergics - tiotropium (Spiriva) |
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Definition
DPI;
Duration of ACtion: 24 hrs;
Place in Therapy:
- pts w/ moderate to severe COPD w/ regular sx or in whom short-acting therapies do NOT provide adequate relief; |
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Term
| Combination Anticholinergics & Beta-2-Agonists - albuterol/ipratropium (Combivent, Duoneb) |
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Definition
MDI, Nebulized soln;
Allows lowest possible effective doses to be used;
Reduces potential adverse effects from individual agents;
May combine short or long-acting products; |
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Term
| Methylxanthines - theophylline (Theo-24, Elixophyllin, Theochron) |
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Definition
Liquids, SR caps & tabs;
No inhalation therapies available - NOT PREFERRED;
Place in Therapy:
- pts intolerant to or unable to use inhaled bronchodilators;
- limited role due to risk for drug interactions & significant variability in dosing;
- serum drug levels must be monitored; |
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Term
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Definition
MoA:
- reduction in capillary permeability to decrease mucus;
- inhibition of release of proteolytic enzymes from leukocytes;
- inhibition of PGs;
Place in Therapy:
- does not appear to modify long-term FEV1 decline;
- may use in symptomatic pts w/ Stage III or Stage IV disease (FEV1 <50%) & repeated exacerbations;
- Long-term use of SYSTEMIC drugs is NOT recommended |
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Term
| Combination LABA + ICS - fluticasone/salmeterol (Advair Diskus), budesonide/formoterol (Symbicort) |
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Definition
Improves FEV1;
reduces sx of dyspnea;
reduces frequency of exacerbations;
Convenient & can decrease total # of inhalations needed daily;
Approved Dose: 250 mcg/50 mcg |
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Term
| acetylcysteine (Mucomyst) |
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Definition
mucolytic;
May benefit pts w/ viscous sputum;
can cause irritation during administration --> further narrowing of airway;
minimal overall benefits: NOT RECOMMENDED |
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Term
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Definition
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Term
| Vitamin E, C, and Beta-Carotene |
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Definition
may be beneficial to restore imbalance b/w oxidants & antioxidants in smoking-induced lung dx;
No good evidence; |
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Term
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Definition
surgical removal of large air spaces that are filled w/ stagnant air;
Used in Stave IV Very Severe COPD |
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Term
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Definition
surgical intervention used at End Stage COPD;
2 yr survival is 65-90% |
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Term
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Definition
Sx: increased sputum volume, acutely worsening dyspnea, chest tightness, purulent sputum, increased need for bronchodilators, malaise, fatigue, decreased exercise tolerance;
PhEX: fever, wheezing, decreased breath sounds;
Diagnostic tests: sputum sample, chest x-ray |
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Term
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Definition
1 cardinal symptom (worsening dyspnea, increased sputum volume, increased sputum purulence)
PLUS at least 1 of following:
- URTI w/in 5 days, unexplained fever, increased wheezing, increased cough, increased RR or HR >20% above baseline |
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Term
| Moderate COPD Exacerbation |
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Definition
| 2 cardinal symptoms (worsening dyspnea, increased sputum volume, or increased sputum purulence) |
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Term
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Definition
| all 3 cardinal symptoms (worsening dyspnea, increased sputum volume, increased sputum purulence) |
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Term
| Goals of COPD Exacerbation Therapy |
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Definition
Prevention of Hospitalization;
Prevention of Acute Respiratory Failure & Death;
Resolution of exacerbation symptoms;
Return to baseline clinical status & QOL; |
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Term
| Non-Pharm Therapy for COPD Exacerbations |
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Definition
Controlled O2 therapy: titrate to SaO2 >90%, monitor ABG for development of hypercapnia;
Non-invasive mechanical ventilation - pts w/ altered mental status, severe acidosis, respiratory arrest, or CV instability; |
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Term
| Pharm Therapy for COPD Exacerbations |
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Definition
Bronchodilators: intensify regimen by increasing doses/frequency to alleviate sx;
Corticosteroids - use Oral or IV therapy, short courses as effective as longer courses & with lower risk of ADRs, if continued for more than 14 days taper dose to avoid HPA axis suppression;
Antimicrobials - select empirical therapy (H. influenzae, M. catarrhalis, S. pneumoniae, H. parainfluenza) |
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Term
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Definition
complication of COPD exacerbation;
righ-sided HF 2ndary to pulmonary HTN;
- Long-term O2 therapy + diuretics used for tx |
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