COPD Snapshot

DEFINE: A lung disease that is a combination of chronic bronchitis and emphysema. This disease limits airflow due to inflammation and C02 retention. These individuals often have a chronic cough, wheezing, shortness of air, and increased mucus production. The also generally have destruction of inter-alveolar septa destruction. Alveoli sacs are where 02 and C02 exchange happens.

1. Smoker
2. Alpha 1 antitrypsin deficiency
3. Chemical irritant exposure

1. Shortness of air
2. Wheezing
3. Tight chest
4. Increased mucus production

1. Barrel chest
2. Clubbing fingernails
3. Wheezes**
4. Rhonchi
5. Decreased lung sounds
6. Thick sputum**
7. Percussion: hyper-resonance
8. Cyanosis

1. Spirometry; FEV1/FVC ratio <70%
2. CBC- may see elevated hit
3. Pulse oximetry: Varies from patient to patient but often seen 88-92%
4. ABG: C02 is often elevated
5. D-dimer
6. Continuous pulse oximetry
7. A1-antitrypsin screen (specifically in those <45 yrs old)
8. CXR: Hyperinflation
9. PFT
10. Sleep studies
11. Sputum culture

STAGES: (FEV1=Amount of air that can be forcefully expelled in 1 second)
1. Stage 1- Mild FEV1 80% greater than or equal to this. May have some mild shortness of air and increase mucus. Also an ongoing chronic cough
2. Stage 2- Moderate FEV1 between 50-79%
3. Stage 3-Severe FEV! Between 30-49%
4. Stage 4- END STAGE Very severe. FEV1 <30%
5. Lung transplant. 02 around the clock

1. Short acting B-agonist: Example: Albuterol scheduled and PRN
2. Anticholinergic-example: Ipratropium, Tiotropium. These meds ease the airways
3. Long Acting B-agonist: Salmeterol, Formoterol
4. Expectorants
5. Oxygen (typical 2-3 L in pm)

1. IV steroids
2. Empiric antibiotic
3. 02 nasal cannula

1. Recent URI
2. Influenza
3. Allergies
4. Environmental irritants
5. Weather changes

1. Vaccination- pneumovax & influenza recommended
2. Smoking cessation
3. Your airflow (in & out) is limited due to obstruction, thus you may have ongoing mild shortness of air. If you shortness of air suddenly increases you should be seen ASAP by a medical healthcare
provider (Emergency Room)
4. Pursed lip breathing
5. Avoid triggers: cold air, infections, air pollutants, cigarette smoke
6. Eat smaller more frequent meals

1. Pulmonologist

1. Chronic anemia
2. Respiratory failure
3. Right ventricular hypertrophy
4. Recurrent lung infections
5. Cor pulmonale: right sided heart failure secondary to COPD

DIFFERENTIAL DIAGNOSIS (Dx that can appear similar)
1. Congestive heart failure
2. Bronchitis
3. Pneumonia: Fever, more acute
4. Asthma: may be younger.
5. Lung cancer
6. Chronic pulmonary embolism
7. Bronchiectasis
8. Reactive airway
9. Bronchospasms

1. Emphysema
2. Blue Bloater
3. Pink Puffer
4. Hypoxic drive theory
5. Hypoxia
6. Hypercapnia
7. Spiromerty
8. FEV1

1. American Lung Association
2. National Heart, Lung, And Blood Institute
3. Medscape
4. COPD Foundation
1. The 5-minute Clinical consult 2015 43rd Edition page 240. Alan J Crop MD, Bryon Veynovich. Editor in Chief Frank J Domino
2. Epocrates COPD May 2016
3. COPD Foundation
4. Healthline, End-Stage COPD, Written by Rachel Nall, RN, BSN, CCRN Medically Reviewed by Mark R Laflamme, MD on November 19, 2015
5. UPMC Life Change Medicine

Update on May 2nd,2016

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