74R. primary Care of COPD Flashcards
how do you diagnose COPD (step by step)
- history
- examination
- chest x ray
- spirometry
what is the mMRC Dyspnoea Scale
mMRC Grade 0
I only get breathless with strenuous exercise
mMRC Grade 1
I get short of breath when hurrying on the level or walking up a slight hill
mMRC Grade 2
I walk slower than people of the same age on the level because of breathlessness, or I have to stop for breath when walking on my own pace on the level
mMRC Grade 3
I stop for breath after walking about 100 metres or after a few minutes on the level
mMRC Grade 4
I am too breathless to leave the house or I am breathless when dressing or undressing
what is the CAT test
COPD Assessment Test
what do you find when examining a COPD patient
can be normal
Vital Signs- RR and O2 sats
General - Cyanosis, Tar staining
chest exam - Hyperinflated chest, crackles, wheeze
what are some of the differential diagnosis of COPD
® Asthma
® Lung cancer
® Tuberculosis
® Bronchiectasis
® Left heart failure
® Interstitial lung disease
® Cystic Fibrosis
® Idiopathic Cough
what 3 symptoms of COPD could be attributed to anything
Breathlessness
wheeze
cough
what are the risk factors of COPD
smoker
older adults over 40
deprived population (4x higher)
who gets lung cancer
smoker
older adults over 40
deprived population
how do you know if its copd or lung cancer (history and exam)
history -
Haemoptysis
persistant cough (3 weeks)
change in cough
weight loss
dyspnoea
chest and shoulder pain
hoarseness
fatigue in smoker 50 yo or older
Exam -
finger clubbing
chest signs
cervical and/or persistant supraclavicular lymphadenopathy
what indicates obstruction on spirometry trace
0.5
what indicates normality on spirometry trace
0.8
Consider COPD, and perform spirometry in which indicators are present in an individual over age 40.
Dyspnoea - progressive, worse w exercise, persistant
chronic cough - recurrent wheeze
chronic sputum production
recurrent lower resp tract infections
history risk factors - tobacco, chemicals
family risk factors - childhood resp infections
what Is the management aims for short, medium and long term COPD
Short - improve symptoms and quality of life
medium- reduce admissions, exacerbations and deterioration in lung function
longer - reduce mortality
what is the initial management of COPD
Smoking cessation
vaccination
active lifestyle and exercise
initial pharmacology
education
manage comorbidities
what are the 3 types of smoking cessation
NRT
Buproprion
Varenecline(champix)
what are the benefits to pulmonary rehabilitation
reduces hospitalization, improves dyspneoa and exercise tolerance, reduction in anxiety
what are the co morbidities that are usually found in patients with COPD
HF
ICH
obesity
Interstitial lung disease
Bronchiectasis
what is the pharmacological management of COPD
Inhaled Corticosteroids
bronchodilators
combination therapies
oral therapies
LAMA/LABA which ones block and which ones open
LAMA - block
LABA- open
out of LAMA and LABA which has a greater effect on exacerbations and decreases hospitalizations
LAMAs
Out of LABA and LAMA which increases FEV1and reduces symptoms compared with what
LABA/LAMA combination
compared to monotherapy
when should you consider LABA+LAMA+ICS
if blood eosinophils >300 and have had >2 moderate exacerbations and > 1 leading to hospitalization
using ICS means patients are more at risk to what?
pneumonia
what is Atopy
the tendency to produce an exaggerated immunoglobulin E immune responses to harmless substances in an environment
should you prescribe glucocorticoids orally long term
no
name 2 mucolytics
carbocysteine and N-acetylcysteine
what do mucolytics do
thin and loosen mucus in airways making it easier to cough up
so summarize the key principles in COPD management
accurate diagnosis, treat co morbidities, stop smoking, vaccinations, pulmonary rehab, nutrition, LABA/LAMA usually, trail of triple Rx if high eosinophils or frequent exacerbations
what is an exacerbation of COPD
an acute worsening of respiratory symptoms that results in additional therapy
what are differential diagnosis for exacerbations of COPD
pneumonia
pneumothorax
pleural effusion
PE
Pulmonary oedema
cardia arrhythmias
how do you manage COPD exacerbations
increase bronchodilators
systemic steroids (no more than 5 days (oral steroid would be fine here))
antibiotics (if indicated(only 5 days (amoxicillin)))
admission if not responding to treatment/are frail/ no support at home/signs of acute resp failure
when referring COPD patients, how do you know when to refer.
diagnosis uncertain
young age
rapid decline of FEV1
for consideration of a lung transplant/ bronchoscopic valves or lung volume reduction surgery
