“#356 Chronic Obstructive Pulmonary Disease (COPD) Update with Dr. Antonio Anzueto” From The Curbsiders With Links To Additional Resources

Posted on October 3, 2022 by Tom Wade MD

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Additional Resources:

The differential diagnosis of COPD is from The Curbsiders’ #356. I have added links to resources on the list.

Differential Diagnosis of COPD

  1. Asthma from emedicine.medscape.com
    Updated: May 11, 2022
    Author: Michael J Morris, MD, FACP, FCCP
  2. Congestive Heart Failure Imaging from emedicine.medscape.com
    Updated: Aug 29, 2022
    Author: Vibhuti N Singh, MD, MPH, FACC, FSCA
  3. Bronchiectasis from emedicine.medscape.com
    1. Bronchiectasis
      Updated: Sep 15, 2020
      Author: Ethan E Emmons, MD
    2. Bronchiectasis Imaging
      Updated: Sep 20, 2017
      Author: Brenda L Holbert, MD, FACR
  4. Vocal Cord Dysfunction
    1. Vocal Cord Dysfunction: Rapid Evidence Review JOHN MALATY, MD, AND VELYN WU, MD. Am Fam Physician. 2021;104(5):471-475
    2. How to do Vocal Cord Ultrasound
      1. Gulf Coast Ultrasound
      2. 1:51, Aug 10, 2021
  5. Obliterative bronchiolitis
    1. Bronchiolitis Obliterans
      1. [ PMC free article ] [ PubMed ] Krishna R, Anjum F, Oliver TI. Bronchiolitis Obliterans. [Updated 2022 Jun 19]. In: StatPearls [Internet]. Treasure Island (FL): StatePearls Publishing; 2022 Jan-.

Indications for high-resolution computed tomography (HRCT) in the evaluation of dyspnea.

Idiopathic interstitial pneumonias: HRCT chest approach
Last revised by Dr Yuranga Weerakkody on 14 May 2019 from Radiopedia

ACR–STR PRACTICE PARAMETER FOR THE PERFORMANCE OF HIGHRESOLUTION COMPUTED TOMOGRAPHY (HRCT) OF THE LUNGS IN ADULTS Revised 2020 (Resolution 33)

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In this post, I link to and excerpt from The Curbsiders‘#356 Chronic Obstructive Pulmonary Disease (COPD) Update with Dr. Antonio Anzueto*.

*Gorth D, Askin CA, Witt L, Anzueto A, Williams PN, Watto MF. “#356 Chronic Obstructive Pulmonary Disease (COPD) Update with Dr. Antonio Anzueto”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list 26 September, 2022.

All that follows is from the above resource.

Transcript-The-Curbsiders-ChronicObstructivePulmonaryDiseaseUpdate.docx

Brush up on your COPD skills and learn some new tips for diagnosis and management of this common respiratory condition from our expert Dr. Antonio Anzueto (University of Texas San Antonio).

COPD Pearls

  1. COPD demographics are evolving: one emerging phenotype is known as “Early COPD,” operationally defined as those less than 50 years old, with a 10-pack-year history of smoking, in conjunction with PFT and/or radiographic abnormalities (Maselli et al 2019); severe early-onset COPD predominantly affects women (66%) (Foreman et al 2011).
  2. Clinically, COPD is differentiated from asthma by responsiveness to bronchodilators and/or the presence of atopic allergic symptoms, but these diseases likely exist on a spectrum (Postma and Rabe 2015).
  3. Iraq war veterans with exposure to burn pits have increased incidence of lung disease (Coughlin and Szema 2019).
  4. The criterion for airflow obstruction (which supports a diagnosis of COPD) is a ratio of FEV1/FVC < 0.70; this ratio comes from the volume of air exhaled in the first second (forced expiratory volume in one second, FEV1) divided by the total volume of air forcibly exhaled from the point of maximal inspiration (forced vital capacity, FVC) (GOLD 2022).
  5. COPD is a treatable disease. The “COPD tripod” of treatment consists of medications, pulmonary rehab, and smoking cessation.
  6. If the patient’s absolute blood eosinophil count is greater than 100/μL, consider prescribing  inhaled corticosteroids, and if greater than 300/μL corticosteroids are recommended (Agusti et al 2018 reproduced in Figure 3.1 in GOLD 2022).
  7. Start with an aggressive LABA/LAMA treatment, your patient is more likely to notice the symptomatic difference and be more likely to consistently take their medication (expert opinion).
  8. If your patient is not using their short-acting rescue medication medication, you’re doing a good job treating their COPD (expert opinion).

Differential Diagnosis

  1. Asthma from emedicine.medscape.com
    Updated: May 11, 2022
    Author: Michael J Morris, MD, FACP, FCCP
  2. Congestive Heart Failure Imaging from emedicine.medscape.com
    Updated: Aug 29, 2022
    Author: Vibhuti N Singh, MD, MPH, FACC, FSCA
  3. Bronchiectasis from emedicine.medscape.com
    1. Bronchiectasis
      Updated: Sep 15, 2020
      Author: Ethan E Emmons, MD
    2. Bronchiectasis Imaging
      Updated: Sep 20, 2017
      Author: Brenda L Holbert, MD, FACR
  4. Vocal Cord Dysfunction
    1. Vocal Cord Dysfunction: Rapid Evidence Review JOHN MALATY, MD, AND VELYN WU, MD. Am Fam Physician. 2021;104(5):471-475
    2. How to do Vocal Cord Ultrasound
      1. Gulf Coast Ultrasound
      2. 1:51, Aug 10, 2021
  5. Obliterative bronchiolitis
    1. Bronchiolitis Obliterans
      1. [ PMC free article ] [ PubMed ] Krishna R, Anjum F, Oliver TI. Bronchiolitis Obliterans. [Updated 2022 Jun 19]. In: StatPearls [Internet]. Treasure Island (FL): StatePearls Publishing; 2022 Jan-.

ACR–STR PRACTICE PARAMETER FOR THE PERFORMANCE OF HIGHRESOLUTION COMPUTED TOMOGRAPHY (HRCT) OF THE LUNGS IN ADULTS Revised 2020 (Resolution 33)

 

 

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