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08/2-7, 2012

SEM 1 Year 2 IV.

[Cough] Chronic Obstructive Pulmonary Disease

CLINICAL FEATURES (from history & PE)

COPD: cough, sputum production, and exertional dyspnea. History: heaviness, air hunger, or gasping - principal feature is worsening dyspnea on exertion - arm work activities, particularly at or above

shoulder level are difficult - advanced stages- patients are breathless doing ADL. PE: odor of smoke or nicotine staining of fingernails - expiratory wheezing - Barrel Chest (Hyperinflation) - Use of Accessory muscle, weight loss, ankle swelling (Cor pulmonale) - Sitting in Tripod postion (facilitate the actions of the SCM, scalene, and ICS)
- Cyanosis:

"pink puffers" - thin and noncyanotic at rest ,use of accessory muscles "blue bloaters"- patients with chronic bronchitis are more likely to be heavy and cyanotic

Pulmonary function testing a. Spirometry- Short acting Beta 2 agonist/ anti cholinergic (measure after 10-15 for b2 agonist, 30-45 for anti-Cholinergic) FEV1 -airflow obstruction with a reduction in FEV1 and FEV1/FVC (<.70) increase in total lung capacity, functional residual capacity, and residual volume (Increased Lung Volume)



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elevated hematocrit suggests the presence of chronic hypoxemia. ADVISE.6 minute unpaced walk test h. Salbutamol 100 or 200 mcg.Obvious bullae. CXR. increases cyclic AMP> antagonism to bronchoconstriction Adverse effect: Tachycardia a. .Fenoterol 100-200 mcg. . bupropion.Pharmacologic: I.Smoking Cessation – Nicotine replacement(gum. Serum Alpha1 Antitrypsin testing. Untreated PUD. Long Acting-Formoterol 4. Arterial blood gases and oximetry -resting or exertional hypoxemia.Reduce Symptoms Reduce Risk A.Tx: Varenicline . Short Acting.alveolar ventilation and acid-base status by measuring arterial PCO2 and pH. . CBC.ARRANGE B. lozenge) except for those w/ CAD.tall R wave. Exercise Testing. stimulating beta2 adrenergic receptors.08/2-7.relax smooth muscle. CT.500 mcg (4-6 hours duration) b. 2012 SEM 1 Year 2 COURSE III: PULMONOLOGY [Cough] Chronic Obstructive Pulmonary Disease b.Right ventricular hypertrophy Cor Pulmonale. recent MI or CVD. TREATMENT Goals. ECG and 2Decho. Bronchodilators Beta 2 Agonist.03 units/10 mmHg in the chronic state c.Inhaler.5 step program: ASK.08 units/10 mmHg acutely and 0. Terbutaline 400.5- DREAMERS ADZU-SOM II COMPILED BY: (CHRISTIAN YECYECAN)  Page 4 of 6 .definitive test presence or absence of emphysema f. ASSESS. as does the presence of signs of right ventricular hypertrophy d. notriptyline . or hyperlucency suggests the presence of emphysema e.Dec 15-20 % of normal g. ASSIST.change in pH with PCO2 is 0. Persistent S wave from V1-V6 VI. paucity of parenchymal markings.tall P wave RV Hypertrophy.

Non Pharmacologic a. Lung Volume Reduction SurgeryImproves mechanical efficacy of resp muscles.blocks acetylcholine’s effect on muscarinic receptors and modifies transmission at the pre ganglionic junction Adverse effects: Dryness of Mouth. Increases elastic recoil pressure and improves Exp. inability to clear secretions. except for CV instability. Salmeterol 25-50 mcg(12 hours) II. AntiCholinergics.if w/ resting hypoxemia/ DREAMERS ADZU-SOM II VI. abd.45mmhg). Alpha1 AT Augmentation Therapy VIII. diarrhea. oral (24 hours) Vaccines. Pain. extreme obesity. Long Acting( M3 and M1)Tiotropium 18 mcg( 24 hours) III. skin bruising. 500mcg.oral(24 hours) A IV.08/2-7. Antittusives C. Phosphodiesterase Inhibitors.for bolus emphysema e. distress despite therapy. resp. Pneumococcal.for reps.200.65 and older VII. risk for pneumonia Beclamethasone 50-400 mcg Budesonide 100.6 minute walking. Convulsions Theophylline -200-600 mg. hoarse voice. C Inhaled ICS + LABA or LACA LACA + LABA D Inhaled ICS + LABA or LA anticholinergi c -Inhaled ICS + LABA/ or Inhaled ICS w/ LABA and LACA Or Inhaled ICS w/ LABA & PDE4 Or LABA + LACA Or LACA+ PDE4 Carbocysteine + SABA and/ or SACA + Theophylline COMPILED BY: (CHRISTIAN YECYECAN)  Page 5 of 6 . Arrest. Mech VentNIPPV-for patients w/ resp failure (PaCO2. sleep distrubances. Education and Nutrition b. Antibiotics IX. with Rt. daily 10-45 minutes II. life threatening hypoxemia 1 Choice SA Anticholinergi c Or SABA (PRN) B LACA or LABA st 2 nd CHoice Alternative Theophyilline LACA or LABA Or SABA + SA anti Cholinergic LABA + LACA SABA and/ or SA anticholinergic + Theophylline PDE 4 inhibitor + SABA and/or SA anticholinergic + Theophylline V. headache Roflumilast. Pulmonary Rehabilitation I. reduced appetite. Flow rates.400 mcg Fluticasone 50-500 mcg o2 sat <88 or <90%. oral candidiasis. Influenza b. Less/ Very Safe a. Heart Failure c.inhibits breakdown of intracellular cyclic AMP Adverse effects: nausea.trauma. Bullectomy. Exercise Training. Methylxanthines. burns Invasive. impaired mental Status.killed or live a. 2012 SEM 1 Year 2 COURSE III: PULMONOLOGY [Cough] Chronic Obstructive Pulmonary Disease 12 mcg. Inhaled Corticosteroids Adverse Effects-risk for reduced bone density. Hypercarbia. Mucolytics and Antioxidants X.Act as non selective phosphodiesterase inhibitors Adverse Effects: Atrial and Ventricular Arrythmia. Oxygen Therapy. d. Short Acting(M2 and M3)Ipratropium Bromide20-40 mcg (6-8 Hours) b.