ASTHMA & COPD

LEARNING OBJECTIVES:

KNOWLEDGE - Students should be able to describe and define:

1. Be able to describe and define the common clinical presentations and diagnostic criteria for emphysema.
2. Describe and define the etiology, pathophysiology, and pathology for COPD.
3. Recommend appropriate laboratory evaluation for suspected COPD exacerbation.
4. Prioritize common causes of acute exacerbations of COPD (AECOPD), including:
   1. Acute infectious bronchitis
   2. Pneumonia
   3. Pulmonary edema
   4. Poor air quality (e.g. ozone, pollutants, tobacco smoke)
   5. Occupational exposures
   6. Medical noncompliance
5. Discuss the etiology, pathogenesis, evaluation and management of hypoxemia and hypercapnia in the context of COPD.
6. Describe and define therapies for COPD, noting advantages, disadvantages, and side effects, for the following:
   1. Beta-agonist bronchodilators
   2. Anticholingeric bronchodilators
   3. Leukotriene inhibitors
   4. Mast cell stabilizers
   5. Theophylline
   6. Inhaled corticosteroids
   7. Systemic corticosteroids
   8. Antimicrobial agents
   9. Supplemental oxygen
   10. Immunotherapy
   11. Smoking cessation
7. Describe and define the role of influenza and pneumococcal vaccine in the care of patients with obstructive airways disease.

SKILLS - Students should demonstrate specific skills, including:

1. History-taking:   Students should be able to obtain, document, and present an age-appropriate medical history, including duration and severity of shortness of breath, sputum production, cough, wheezing, hemoptysis, fever, abnormal nocturnal/diurnal sleep patterns, patient's occupational history, including current and past exposures, environmental, smoking (active and passive).
2. Physical Exam:   Students should be able to perform a physical exam to establish the diagnosis and severity of disease, including accurate assessment of the use of accessory muscles for breathing, accurate determination of pulsus paradox, and accurate recognition of abnormal breath sounds.
3. Differential Diagnosis:   Students should be able to generate a differential diagnosis recognizing specific history and physical exam findings that confirm or refute a diagnosis of asthma, chronic bronchitis, or emphysema.
4. Laboratory Interpretation:   Students should be able to recommend when to order and how to interpret a chest x-ray, spirometry, arterial blood gases, sputum gram stain, and pulse oximetry in the evaluation of patients suffering from obstructive airways disease.
5. Communication Skills:   Students should be able to communicate the diagnosis, prognosis, and treatment plan of the disease to patients and their families.
6. Basic Procedural Skills:   Students should be able to proficiently obtain arterial blood gas samples.
7. Management Skills:   Students should be able to develop an appropriate management and treatment plan of patients with obstructive airways disease, demonstrating an understanding of the basic principles of oxygen, antibiotic, bronchodilator, and corticosteroid therapy, applying smoking cessation strategies where applicable, and recommending appropriate pneumovax and influenza vaccinations.
8. Computers in Medicine: Students should be able to efficiently search the literature to identify relevant, up to date information and practice guidelines related to the management of asthma and/or COPD.

ATTITUDES AND PROFESSIONAL BEHAVIORS:  

• Students should recognize that poor working, living, and environmental conditions can contribute to respiratory tract disease.
  

REFERENCES:

1. Chronic Bronchitis, Emphysema, and Airway Obstruction, Harrison's Textbook of Medicine , 15 th Edition, New York, McGraw Hill, 2001, pp 1491-1499.
2. COPD, Harrison's On-Line: http://harrisons.accessmedicine.com/server-java/Arknoid/amed/harrisons/co_chapters/ch252/ch252_p01.html .
3. Sutherland ER and Cherniack RM.   Management of Chronic Obstructive Pulmonary Disease.   NEJM 2004;350:2689-97. A terrific up-to-date review of the overall approach to managing patients with COPD.
4. Wood-Baker, R et al.   Oral corticosteroids for acute exacerbations of chronic obstructive pulmonary disease.   The Cochrane Database of Systematic Reviews Volume 1, 2003.
5. Barnes, P.   Chronic Obstructive Pulmonary Disease.   NEJM 2000; 343(4): 269-80.