Questions and Answers
What is the primary factor that contributes to the development of Chronic Obstructive Pulmonary Disease (COPD)?
Which of the following physical findings is NOT typically associated with COPD?
What is the primary purpose of Pulmonary Function Tests (PFTs) in the diagnosis of COPD?
Which of the following comorbidities is commonly associated with COPD?
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Which of the following lifestyle modifications is NOT recommended for patients with COPD?
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What is the term for the number of packs of cigarettes smoked per day multiplied by the number of years smoked?
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Which of the following medications is NOT typically used to treat COPD?
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What is the term for the abnormal permanent dilation of the airways, which can be a comorbidity with COPD?
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Which of the following is a common symptom of COPD exacerbations?
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What is the term for the right heart failure that can occur as a complication of COPD?
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Study Notes
COPD Diagnosis and Management
- COPD diagnosis is confirmed by spirometry, which is required to make a diagnosis.
- The presence of a post-bronchodilator FEV1/FVC < 70% confirms the presence of persistent airflow limitation.
Initial Assessment
- Once COPD is diagnosed, the assessment must focus on determining four fundamental aspects:
- Severity of airflow limitation
- Nature and magnitude of current symptoms
- Previous history of moderate and severe exacerbations
- Presence and type of other diseases (multimorbidity)
Treatment for COPD
- For a patient with a Modified Medical Research Council Dyspnea Scale score of 1, the Global Initiative for Chronic Obstructive Lung Disease recommends a long-acting muscarinic antagonist (LAMA) monotherapy.
- Other treatment options include:
- Inhaled corticosteroid (ICS) monotherapy
- Long-acting beta2 agonist (LABA) monotherapy
- Short-acting beta2 agonist monotherapy
COPD Exacerbation
- An exacerbation of COPD is defined as an event characterized by dyspnea and/or cough and sputum that worsen over < 14 days.
- Exacerbations are often associated with increased local and systemic inflammation caused by airway infection, pollution, or other insults to the lungs.
- Recovery time from an exacerbation varies, taking up to 4-6 weeks to recover, with some patients failing to return to the pre-exacerbation functional state.
Symptoms and Presentation
- Chronic cough
- Shortness of breath/dyspnea on exertion
- Loss of appetite
- Orthopnea
- Fatigue and weakness
- Sputum production
- History of recurrent lower respiratory tract infections with or without exposure to risk factors
- Smoking history: pack-year (number of packs of cigarettes per day times number of years the person smoked)
- Occupational and environmental exposures
- Family history
- Past Medical History – Asthma, allergies, childhood respiratory infections
Physical Findings
- General:
- Significant respiratory distress in acute exacerbations
- Muscle wasting
- Chest:
- Increased Anterior-posterior chest wall diameter (barrel chest)
- Wheezing
- Prolonged expiration
- Pursed-lip breathing
- Skin:
- Central cyanosis when arterial oxygenation is low
- Extremities:
- Digital clubbing
- Lower extremity edema in right heart failure
Differential Diagnosis
- Asthma
- Bronchiectasis
- Chest wall disorders
- Congestive heart failure
- Cystic fibrosis
- Diffuse panbronchiolitis
- Interstitial lung disease
- Lung Cancer
- Medication side effects
- Mesothelioma
- Nontuberculous mycobacteria infection
- Obliterative bronchiolitis
- Pulmonary arterial hypertension
- Tracheal stenosis
- Tuberculosis
- Upper airway obstruction (tracheal tumor)
- Vocal cord dysfunction
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Description
Learn about the diagnosis and assessment of Chronic Obstructive Pulmonary Disease (COPD) through spirometry and post-bronchodilator FEV1/FVC ratio. Understand the key aspects to determine severity of airflow limitation and symptoms.
