Etiology
Which is not a clinical feature of a COPD exacerbation?
A) Loud breath sounds on auscultation
B) Diffuse wheezing
C) Tachycardia
A
-Inhaled beta agonist (albuterol)
-Short-acting muscarinic agonist (Ipratropium)
-IV glucocorticoids (methylpredisone)
What is one physiological reason that patients with COPD are more prone to respiratory infections.
They have impaired ciliary clearance
How should oxygen saturation be assessed?
Via continuous pulse oximetry
When influenza is suspected in a COPD exacerbation, should you start treatment prior to lab confirmation?
Yes
What is the biggest risk factor for COPD?
Smoking
The typical duration for antibiotic therapy in acute COPD exacerbations.
5 to 7 days
Serious illness and death in COPD patients can be reduced by about ____ % with annual influenza vaccination.
A) 30%
B) 50%
C) 40%
50%
Should peak expiratory flow be assessed in patients with severe COPD exacerbations?
No, the results are not accurate
What is the SpO2 goal for COPD patients?
88-92%
1) Broad-spectrum antibiotics
2) Chronic systemic glucocorticoid use
- 1/3 to 2/3
FEV1 < 30%, bronchiectasis on chest imaging, broad-spectrum abx use in past 3 months, or chronic systemic glucocorticoid use are all risk factors for which bacterial infection associated with COPD exacerbations?
High FiO2 delivery in COPD exacerbations is a risk factor for which complication of COPD therapy?
- Hypercapnia
(High FiO2 requirement should prompt consideration of an alternative dx such as PE)
What should the PaO2 target be?
60 or 70
What is the most common cause of a COPD exacerbation?
A viral or bacterial lung infection
- Cefepime
- Ceftazidime
-Piperacillin-tazobactam
These pathogens are the 3 most common bacterial causes for acute COPD exacerbation.
- Haemophilus influenzae
- Moraxella catarrhalis
- Streptococcus pneumoniae
Unlike acute asthma exacerbations, combination therapy with which two agents has not been shown to be beneficial compared to use of one of the agents alone?
Albuterol and ipratropium
-About 1/2 of patients will see a significant increase in FEV1 after bronchodilators, however, there do not seem to be any significant differences between anticholinergics and beta-agonists.
Non-invasive ventilation
An imbalance between ____________ and _______________ in the lung and oxidative stress are thought to be important in the pathogenesis of COPD.
proteinases and antiproteinases
Although guidelines have not yet been established, which two criteria may help determine potential benefits for antibiotic therapy in outpatient's with COPD exacerbation?
- Elevated CRP
- Sputum production
Viral-induced COPD exacerbations have been shown to stimulate which receptor in the airways that contributes to the disease process?
Muscarinic receptor stimulation
(in addition to airway epithelial cell damage and induction of inflammatory mediators)
-Inspiratory pressure: 8 cm H2O (may increase up to 15 cm H2O)
-Expiratory pressure: 3 cm H2O
What are 3 contraindications to noninvasive ventilation in a COPD exacerbation?
1) Severely impaired consciousness
2) Inability to clear secretions/protect airway
3) High aspiration risk
4) Facial surgery/trauma/deformity
5) Recent esophageal anastomosis