COPD [Autosaved].pdf

Chronic Obstructive Pulmonary Disease (COPD) Dr. Ramaswamy, PhD, MPH, APRN, FNP-C COPD Definition (GOLD 2024): A heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, sputum production and/or exacerbations) due to abnormalities of the airways (bronchitis, bronc...

Chronic Obstructive Pulmonary Disease (COPD) Dr. Ramaswamy, PhD, MPH, APRN, FNP-C COPD Definition (GOLD 2024): A heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, sputum production and/or exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction. Chronic bronchitis & emphysema Disorders of airflow limitation/alveolar abnormalities Usually caused by significant exposure to noxious particles or gases Difficult to reverse damage Zerwekh, J. (2007). COPD. [Illustration]. Retrieved from https://www.pinterest.co.uk/pin/565553665689607616/ COPD Statistics (CDC) Overall, 6th leading cause of death in the U.S in 2021. An estimated 14.2 million adults had a dx of COPD in 2021 10.3 million office visits Annual cost $49.0 billion (CDC) COPD is preventable and treatable COPD Risk Factors Environmental: Tobacco smoke COPD results from dynamic, Air pollution cumulative and repeated gene – environment interactions over the Occupational exposures lifetime of the individual that damage Genetic: the lungs and/or alter their normal development/aging processes Alpha1-antitrypsin deficiency Lung Development Early childhood factors – prematurity, low birth weight, maternal smoking Allergic conditions – Asthma Infections, Low SES  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  COPD Pathology Lewis, S., Bucher, L., Heitkemper, M., & Harding, M. (2017). Pathophysiology of COPD. [Illustration]. Medical surgical nursing: Assessment and management of clinical problems. St Louis: Mosby. Subjective Clinical 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 Subjective –History (PMH, FH, Social) Smoking history: pack-year (number of packs of cigarettes per day times number of years the person smoked) Occupational and Environmental Exposures Secondhand smoke Family history Past Medical History – Asthma, allergies, childhood respiratory infections Objective Physical Findings General Chest Significant respiratory distress in acute Increased Anterior-posterior chest wall exacerbations diameter (barrel chest) Muscle wasting Skin Lungs Central cyanosis when arterial oxygenation is low Accessory respiratory muscle use Extremities Prolonged expiration Digital clubbing Wheezing Lower extremity edema in right heart Pursed-lip breathing failure Diagnosis of COPD Symptoms: Exposure to risk factors: - Dyspnea - Tobacco - Chronic cough - Occupational exposures - Sputum production - Indoor/outdoor pollution - History of lower respiratory tract infections PFTs (spirometry) (required for diagnosis)  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Differential Diagnosis Asthma Mesothelioma Bronchiectasis Nontuberculous mycobacteria infection Chest wall disorders Obliterative bronchiolitis Congestive heart failure Pulmonary arterial hypertension Cystic fibrosis Tracheal stenosis Diffuse panbronchiolitis Tuberculosis Interstitial lung disease Upper airway obstruction (tracheal tumor) Lung Cancer Vocal cord dysfunction Medication side effects Cagle, S.D., Landrum, L.S., & Kennedy, A.M. (2023). Chronic obstructive pulmonary disease: Diagnosis and Management. American Family Physician, 107(6), 604-612.  Spirometry For diagnosis and assessment of COPD Spirometry is required to make diagnosis The presence of a post-bronchodilator FEV1/FVC < 70% confirms the presence of persistent airflow limitation  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE Other Diagnostic Tests Chest radiography Laboratory Tests: CMP, CBC diff, serum alph1-antitriypsin level Gram stain Electrocardiogram (EKG) Pulse oximetry Initial Assessment Once COPD diagnosis is confirmed by spirometry, COPD assessment must focus on determining the following four fundamental aspects, in order to guide therapy: Severity of airflow limitation Nature and magnitude of current symptoms Previous history of moderate and severe exacerbations Presence and type of other diseases (multimorbidity)  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE Cagle et al., 2023  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE Cagle et al., 2023 Treatment for COPD (Contd.) Cagle et al., 2023  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE 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 of COPD are often associated with increased local and systemic inflammation caused by airway infection, pollution, or other insults to the lungs Consider relevant different diagnoses such as pneumonia, CHF and pulmonary embolism during evaluation Exacerbation recovery time varies, taking up to 4-6 weeks to recover, some failing to return to the pre-exacerbation functional state  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE  Teaching Slide Set © 2023, 2024 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE Cagle et al., 2023 COPD Case – A 55-year-old patient is diagnosed with chronic obstructive pulmonary disease (COPD) confirmed by spirometry. He has never been hospitalized for a COPD exacerbation, and he notes dyspnea only when hurrying to get somewhere or walking up a slight hill, which gives him a Modified Medical Research Council Dyspnea Scale score of 1. Which one of the following treatments would be recommended by the Global Initiative for Chronic Obstructive Lung Disease for this patient? A. Inhaled corticosteroid (ICS) monotherapy. B. Long-acting beta2 agonist (LABA) monotherapy. C. Long-acting muscarinic antagonist (LAMA) monotherapy. D. Short-acting beta2 agonist monotherapy. COPD Case A 55-year-old patient is diagnosed with chronic obstructive pulmonary disease (COPD) confirmed by spirometry. He has never been hospitalized for a COPD exacerbation, and he notes dyspnea only when hurrying to get somewhere or walking up a slight hill, which gives him a Modified Medical Research Council Dyspnea Scale score of 1. Which one of the following treatments would be recommended by the Global Initiative for Chronic Obstructive Lung Disease for this patient? A. Inhaled corticosteroid (ICS) monotherapy. B. Long-acting beta2 agonist (LABA) monotherapy. C. Long-acting muscarinic antagonist (LAMA) monotherapy. D. Short-acting beta2 agonist monotherapy. References Cagle, S.D., Landrum, L.S., & Kennedy, A.M. (2023). Chronic obstructive pulmonary disease: Diagnosis and Management. American Family Physician, 107(6), 604-612. Dunphy, L., Winland-Brown, J., Porter, B., & Thomas, D. (2023). Primary care: Art and science of advanced practice nursing (6th ed). Philadelphia: F.A. Davis. Global Initiative for Chronic Obstructive Lung Disease. (2024). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Retrieved from https://goldcopd.org/ Lewis, S., Bucher, L., Heitkemper, M., & Harding, M. (2017). Normal lungs showing bronchioles and alveoli and changes in the bronchioles and alveoli in the lungs of a patient with COPD. [Illustration]. Medical surgical nursing: Assessment and management of clinical problems. St Louis: Mosby. Lewis, S., Bucher, L., Heitkemper, M., & Harding, M. (2017). Pathophysiology of COPD. [Illustration]. Medical surgical nursing: Assessment and management of clinical problems. St Louis: Mosby. University of California San Diego. (2015). Patient with emphysema bending over in tri-pod position. [Photograph]. Retrieved from https://meded.ucsd.edu/clinicalmed/lung.htm Zerwekh, J. (2007). COPD. [Illustration]. Retrieved from https://www.pinterest.co.uk/pin/565553665689607616/