Chronic Obstructive Pulmonary Disease
Pulmonary and Critical Care Medicine · Airways Disease 🎯 Practice these cards
COPD is confirmed by a postbronchodilator FEV1/FVC ratio less than ____.
COPD is confirmed by a postbronchodilator FEV1/FVC ratio less than 0.70, demonstrating airflow limitation that is not fully reversible (unlike asthma).
GOLD 1 (mild) = FEV1 ≥ ____% predicted; GOLD 4 (very severe) = FEV1 < ____%.
GOLD grades airflow limitation (with FEV1/FVC < 0.70): GOLD 1 mild = FEV1 ≥ 80% predicted; GOLD 2 moderate = 50–79%; GOLD 3 severe = 30–49%; GOLD 4 very severe = FEV1 < 30%.
mMRC grade ____ = too breathless to leave the house, or breathless when dressing.
mMRC grades breathlessness: 0 only with strenuous exercise; 1 hurrying/up a slight hill; 2 slower than peers or stops at own pace; 3 stops after ~100 yards; 4 too breathless to leave the house or breathless when dressing.
The BODE index uses four variables: B = body mass index, O = airflow ____, D = ____, E = ____ capacity.
The BODE index predicts 4-year survival better than FEV1 alone: B = body mass index, O = airflow obstruction (FEV1 % predicted), D = dyspnea (mMRC), E = exercise capacity (6-minute walk distance).
Approximate 4-year survival: BODE 0–2 points ≈ ____%; BODE 7–10 points ≈ ____%.
Approximate 4-year survival by BODE score: 0–2 points ≈ 80%; 3–4 ≈ 67%; 5–6 ≈ 57%; 7–10 ≈ 18%.
Long-term oxygen improves survival at resting PaO2 ≤ ____ mm Hg or SpO2 ≤ ____%.
Long-term oxygen improves survival at resting PaO2 ≤ 55 mm Hg or SpO2 ≤ 88% (or ≤ 59 mm Hg / ≤ 89% with cor pulmonale, heart failure, or erythrocytosis). Benefit is proportional to hours of daily use.
ICS exacerbation benefit is minimal below ____ eosinophils/µL and ICS are recommended above ____/µL.
In COPD, ICS exacerbation benefit is minimal below 100 eosinophils/µL, rises above 100, and ICS are recommended as initial therapy above 300/µL. ICS are never used alone and increase pneumonia risk.
An acute COPD exacerbation is treated with oral prednisone ____ mg for ____ days.
Acute COPD exacerbations are treated with oral prednisone 40 mg for 5 days; short, lower-dose oral courses are equivalent to longer/higher/IV regimens. Hyperglycemia is the most common acute complication.
During a COPD exacerbation, supplemental oxygen is titrated to a target SpO2 of ____–____%.
During an exacerbation, supplemental oxygen is titrated to a target SpO2 of 88–92%. Correcting hypoxemia may modestly raise PaCO2 but does not reduce minute ventilation and should not be withheld.
Since 2023 GOLD classifies patients as groups A, B, and ____; the high-risk group is defined by ≥ ____ moderate exacerbations per year or ≥ 1 hospitalization.
Since 2023 GOLD groups patients as A, B, and E (the former C and D merged into E). Group E = ≥ 2 moderate exacerbations/year or ≥ 1 hospitalization, regardless of symptoms.
The three interventions proven to improve survival in COPD are smoking cessation, long-term ____, and lung-volume-reduction ____.
Only three interventions are proven to improve survival in COPD: smoking cessation, long-term oxygen in chronically hypoxemic patients, and lung-volume-reduction surgery in selected emphysema patients.
____, an anti-IL-4/IL-13 antibody, became the first FDA-approved biologic for COPD (Sept 2024) for patients with blood eosinophils ≥ ____/µL on maximal inhaled therapy.
Dupilumab (anti-IL-4/IL-13) became the first FDA-approved biologic for COPD in September 2024, for uncontrolled COPD with blood eosinophils ≥ 300/µL on maximal inhaled therapy (BOREAS/NOTUS: ~30–31% exacerbation reduction).
Ensifentrine (2024) is a first-in-class inhaled dual ____/____ inhibitor.
Ensifentrine (FDA June 2024) is a first-in-class inhaled (nebulized, twice-daily) dual PDE3/PDE4 inhibitor combining bronchodilation with non-steroidal anti-inflammatory effects — the first new inhaled COPD mechanism in >20 years.
LVRS is contraindicated when FEV1 < ____% predicted with DLCO < ____% or diffuse (non-upper-lobe) disease.
LVRS benefits upper-lobe-predominant emphysema with low post-rehab exercise capacity, but is contraindicated when FEV1 < 20% predicted with DLCO < 20% or diffuse (non-upper-lobe) disease (high operative mortality).
α1-antitrypsin deficiency classically causes ____-lobular emphysema with a ____-lobe predominance.
α1-antitrypsin deficiency classically causes panlobular emphysema with a lower-lobe (basilar) predominance; a level should be checked once in every patient with COPD.
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