3. COPD Flashcards
What’s the cause of
COPD
Smoking
COPD
which vaccine do they needy yearly
Influenza
Pneumococcal vaccine
emphysema
Symptoms
Frequent coughing or wheezing.
A cough that produces a lot mucus.
Shortness of breath, especially with physical activity.
A whistling or squeaky sound when you breathe.
Tightness in your chest.
What is
Emphysema
Emphysema
is a lung condition that causes breathing difficulties. This and chronic (or long-term) bronchitis are the two main components of COPD. If you have emphysema, the walls of the air sacs in your lungs are damaged
COPD
What is it?
Chronic obstructive pulmonary disease, or COPD, describes a group of lung conditions that make it difficult to empty air out of the lungs because the airways have become narrowed.
Emphysema + chronic bronchitis = COPD
COPD
symptoms
Frequent coughing or wheezing all day
Excess phlegm or sputum.
Shortness of breath.
Trouble taking a deep breath.
Differentiate between
asthma & COPD
ICS
In asthma ICS help
3-4 weeks
ICS don’t help with COPD
Is COPD
Reversible?
No.
Irreversible air way obstruction
Asthma
Reversible?
Yes;
Reversible airway obstruction
COPD TX
If no asthmatic features
Productive cough, night + day
Step 1️⃣ is for ALL COPD
1️⃣ SABA/ SAMA prn
2️⃣non asthmatic features
LAMA+ LABA
if 1 severe or 2 moderate exacerbations
ADD: ICS
If Dady to day symptoms affect quality of life:
ADD: ICS for 3 months
(If no improvement remove ICS, refer SPECIALIST)
COPD TX
If asthmatic features
Step 1️⃣ is for ALL COPD
1️⃣ SABA/ SAMA prn
2️⃣asthmatic features
LABA + ICS
if 1 severe or 2 moderate exacerbations
OR
If Day to day symptoms affect quality of life:
ADD: LAMA
( NO improvement ? —> refer SPECIALIST)
The GOLD
COPD guidelines
FORCED EXPIRATORY VOLUME IN 1 second
FEV1 >50%
FEV1 <50%
= or more than 50%
Use LABA / LAMA
Less than 50%
Add ICS
Still no improvement
Triple therapy
LAMA + LABA + ICS
Target oxygen level in COPD
88-92%
Careful of hypercapnic respiratory failure (if history, carry a O2 alert card)
(High O2 will cause CO2 retention)
When does a COPD patient carry a
O2 Altert Card
History of hypercapnic respiratory failure
HCP to use a 24% or a 28% Venturi mask (with 02 therapy)
Antimuscarinic bronchodilators
Such as
ipratropium
tiotropium,
aclidinium
glycopyrronium
Caution in:
Prostatic hyperplasia
At risk of angle closure glaucoma
LABA
in
COPD
List: 3
Olodaterol - striverdi respimat
Indacaterol - onbrez breezhaler
Vilanterol + umeclidinium - anora elipta (combo)
SAMA
Short acting antimuscarinic
In
COPD
Ipratropium
LAMA
in
COPD
List
Aclidinium - eklira genuair BD
Glycopyronnium - seebri breezhaler OD
Umeclidinium - incruse elipta OD
Tiotropium - spiriva handihaler OD
When can tiotropium- spiriva respimat
Be used in asthma pts who are already taking a LABA + ICS
Pts who suffered 1 or more severe acute exacerbation in the past year
Start inhaled therapy ONLY if:
3
- the non pharmacological steps haven been offered.
- inhaled therapy is needed to relieve breathlessness
- pts are trained adequately on inhaler technique
Non pharmacological first steps before
Medicine
COPD
Stop smoking
Take the influenza & pneumococcal vaccines
Acute COPD
Tx
- SABA/ SAMA
via nebuliser with O2
No improvement?
IV Aminophylline
COPD
After Acute attack
SOB interferes with day to day life
General Tx
If SOB interferes with daily life
Oral Prednisolone 30mg 7-14 days
If purulent sputum / high fever/ swollen lymph nodes
Or other signs of infection : ABX amoxicillin/ clarithromycin
