Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease characterized by airflow limitation that is usually progressive and associated with an abnormal inflammatory response in the lungs. The diagnosis of COPD requires two spirometric measures: FEV1 and its ratio to FVC (FEV1/FVC), which must be less than 0.7. Treatment involves smoking cessation, vaccinations, bronchodilators, corticosteroids, pulmonary rehabilitation, and oxygen therapy or lung transplantation for advanced cases.

1. COPD – Harrison Club
Internal Medicine
PGY-1
Ranjita Pallavi

2. Chronic Obstructive Pulmonary Disease (COPD) is a preventable and
treatable disease with some significant extrapulmonary effects that may
contribute to the severity in individual patients. Its pulmonary
component is characterized by airflow limitation that is not fully
reversible. The airflow limitation is usually progressive and associated
with an abnormal inflammatory response of the lung to noxious particles
or gases.

4.  Smoking
 Airway Responsiveness and COPD
 Respiratory infections
 Occupational exposure
 Ambient Air Pollution
 Passive smoke exposure
 Genetic Considerations

5.  Allelles: M,S,Z and Null
 Most common deficiency PiZ
 1-2% of COPD patients with severe alpha 1 AT
deficiency
 Early onset COPD
 Variability among PiZ individuals: explained
by Smoking/Asthma/COPD
 Risk in PiMZ individuals

6. In patients of Caucasian descent who develop COPD at a young
age (< 45 years) or who have a strong family history of the
disease, it may be valuable to identify coexisting alpha-1
antitrypsin deficiency. This could lead to family screening or
appropriate

8.  Airflow Obstruction
 Hyperinflation
 Gas exchange

9.  LargeAirways
 SmallAirways
 Lung Parenchyma
Large Airways
Small Airways
Lung Parenchyma

10.  Elastase:Antielastase Hypothesis
Large Airways
Small Airways
Lung Parenchyma

11.  History
 Physical Examination
 Lab Findings
Large Airways
Small Airways
Lung Parenchyma

12. The diagnosis and staging of COPD require what two spirometric
measures?

13. FEV1/FVC
FEV1

14. FEV1/FVC < 0.7.
The diagnosis of COPD is confirmed when a post-bronchodilator:

15. Large Airways
Small Airways
Lung Parenchyma

16. Spirometric classification has proved useful in predicting health
status, utilization of healthcare resources, research, development of
exacerbations and mortality.

17. In advanced COPD, measurement of arterial blood gases while the
patient is breathing air is important.This test should be performed in
stable patients with FEV1 < 50% predicted or with clinical signs
suggestive of respiratory failure or right heart failure.

18.  Chest X ray
 CTChest
Large Airways
Small Airways
Lung Parenchyma

19.  History
 Physical Examination
 Lab Findings
Large Airways
Small Airways
Lung Parenchyma

20. The Public Health Service recommends a five-step program (the
five A’s) for smoking cessation intervention. After ASK, ADVISE,
ASSESS, and ASSIST, what is the last step in the GOLD
guidelines?

21.  ASK Systematically identify all tobacco users at every visit
 ADVISE Strongly urge all tobacco users to quit
 ASSESS Determine willingness to make a quit attempt.
 ASSIST Aid the patient in quitting
 ARRANGE Schedule follow-up contact

22. True or False: Influenza vaccine and pneumococcal polysaccharide vaccine
are recommended for all COPD patients.

23. False: In COPD patients, influenza vaccines can
reduce serious illness. Pneumococcal polysaccharide vaccine is
recommended for COPD patients 65 years
and older and for COPD patients younger than age 65 with an FEV1 <
40% predicted

24. Nutritional support had no significant effect on anthropometric
measures, lung function or exercise capacity in patients with stable
COPD.Although some quality of life indices gave significant findings,
these results were from a single small unblinded study and restricted
to certain domains of health status measurements. More work in this
particular area is needed to establish whether supplementation can
lead to subjective benefits in quality of life.
Cochrane Database, 2007

25.  Anticholinergic Agents
 Beta-2 Agonists
 Inhalational Corticosteroids
 Oral Corticosteroids
 Theophylline
 Oxygen
 N-acetyl cysteine
 Alpha-1 AT augmentation therapy

26.  PatientAssessment
 Identify PrecipitatingCauses
 Bronchodilators
 Corticosteroids
 Antibiotics
 Oxygen
 MechanicalVentilator Support

27.  General Medical Care
 Pulmonary Rehabilitation
 LungVolume Reduction Surgery
 LungTransplantation

28. Rehabilitation relieves dyspnea and fatigue, improves emotional
function and enhances patients’ sense of control over their condition.
These improvements are moderately large and clinically significant.
Rehabilitation forms an important component of the management of
COPD.
Cochrane Database, 2007

29. The long-term administration of oxygen (> 15 hours per day) to
patients with chronic respiratory failure has been shown to increase
survival. It can also have a beneficial effect on hemodynamics,
hematologic characteristics, exercise capacity, lung mechanics and
mental state.

30. Long-term home oxygen therapy improved survival in a selected
group of COPD patients with severe hypoxaemia (arterial PaO2 less
than 55 mm Hg (8.0 kPa)). Home oxygen therapy did not appear to
improve survival in patients with mild to moderate hypoxaemia or in
those with only arterial desaturation at night.

31.  PaO2 < 55 mm Hg, or SaO2 < 88 %, at rest, breathing room air.
 PaO2 < 55 mm Hg, or SaO2 < 88 %, during sleep for a patient who
demonstrates an PaO2 > 56 mm Hg, or SaO2 > 89 percent, while
awake.
 PaO2 < 55 mm Hg or SaO2 < 88%, during exercise for a patient who
demonstrates an PaO2 > 56 mm Hg, or SaO2 > 89 percent during
the day, while at rest.

32.  PaO2 is 56-59 mm Hg or whose SaO2 = 89%, if there is evidence of:
 Dependent edema suggesting congestive heart failure;
 Pulmonary hypertension or cor pulmonale, determined by
measurement of pulmonary artery pressure, gated blood pool scan,
echocardiogram, or “P” pulmonale on EKG (P wave greater than 3
mm in standard leads II, III, orAVF); or
 Erythrocythemia with a hematocrit greater than 56 percent.

34. Wise R, Tashkin D. AJM 2007;120:S4

35. Patients with FEV1/DLco < 20% of predicted AND homogeneous
(diffuse) distribution of emphysema are at high risk for death after
surgery and are unlikely to benefit from lung volume reduction
surgery (LVRS).
NETT. NEJM 2001;345:1075-83.

36.  Guidelines for Referral
 BODE index exceeding 5
 Guidelines forTransplantation
 Patients with a BODE index of 7 to 10 or at least 1 of the following:
 History of hospitalization for exacerbation associated with acute
hypercapnia (PCO2 exceeding 50 mm Hg)
 Pulmonary hypertension or cor pulmonale, or both despite oxygen
therapy.
 FEV1 of less than 20% and either DLCO of less than 20% or
homogenous distribution of emphysema.
ISHLT Guidelines. JHeartLungTrans.2006;25:745

37. What is BODE an acronym for?

38. Celli B, et al. NEJM. 2004;350:1005