Case 10 LOL Flashcards
What is diagnosis of COPD based on?
symptoms •breathing sounds •smoking history •BMI •family history of lung problems •breathing tests e.g. spirometry
What tests can be used to diagnose COPD?
Spirometry Chest x-ray Blood tests electrocardiogram (ECG) echocardiogram; peak flow test; blood oxygen test CT scan phlegm sample
How does spirometry work?
Takes 2 measurements:
1.the volume of air you can breathe out in a second(FEV1)
2.total amount of air you breathe out(FVC)
On a time volume graph, FEV1 is worked out by finding y reading from x=1. FVC is the highest point of the curve
What does a blood test test for?
Anaemia
Polycythaemia
alpha-1-antitrypsin deficiency
What are the main inhalers used for COPD?
Short-acting bronchodilator inhalers
Long-acting bronchodilator inhalers
Steroid inhalers
What is a Short-acting bronchodilator inhaler?
First treatment
Used when you feel breathless upto max 4 times a day
2 types:
beta-2 agonist inhalers-such as salbutamol and terbutaline
antimuscarinic inhalers-such as ipratropium
What is a long-acting bronchodilator?
for people who experience symptoms regularly throughout the day
Each dose lasts for at least 12 hours, so they only need to be used once or twice a day
There are 2 types of long-acting bronchodilator inhalers:
beta-2 agonist inhalers-such as salmeterol, formoterol and indacaterol
antimuscarinic inhalers-such as tiotropium, glycopyronium and aclidinium
some new inhalers contain a combination of a long-acting beta-2 agonist and antimuscarinic
What are steroid inhalers?
or people who still become breathless when using a long-acting inhaler, or they have frequent flare-ups(exacerbations)
Steroid inhalers are normally prescribed as part of a combination inhaler that also includes a long-acting medicine
What tablets can be used to treat COPD?
Theophylline tablets
Mucolytics
Steroid tablets
Antibiotics
What are Theophylline tablets?
Type of bronchodilator
Relaxes muscles of airway and reduces inflammation
How do mucolytics work?
E.g. carbocisteine
Makes phlegm thinner and easier to cough up
If carbocisteine doesn’t help try acetylcysteine- powder that you mix with water
How do steroid tablets work?
If you have a particularly bad flare-up, you may be prescribed a short course of steroid tablets to reduce the inflammation in your airways.
A 5-day course of treatment is usually recommended
What does pulmonary rehabilitation involve?
Physical exercise training
Education about condition
Dietary advice
Physiological and emotional; support
What is a nebuliser?
a machine is used to turn liquid medicine into a fine mist that you breathe in through a mouthpiece or a face mask
Enables large dose of medicine to be taken at once
What is roflumilast?
Medicine that treats flare-ups
Recommended for people whose symptoms have suddenly become worse at least 2 times over the past 12 months, and who are already using inhalers
Comes as a tablet
What is long-term oxygen therapy?
If COPD causes you to have low levels of oxygen in blood you may be given oxygen at home
Should be used for at least 16 hours a day
Portable oxygen tanks if away from home
What is ambulatory oxygen therapy?
Oxygen for when you walk or are active
Given for those whose oxygen levels are fine at rest but fall when active
What is non invasive ventilation?
Used if you’re taken to hospital for bad flare up
Portable machine connected to mask that covers nose or face used
What surgeries can be used to treat COPD?
- bullectomy-removes a pocket of air from one of the lungs, allowing the lungs to work better and make breathing more comfortable
- lung volume reduction surgery-removes a badly damaged section of lung to allow the healthier parts to work better and make breathing more comfortable
- lung transplant-removes and replaces a damaged lung with a healthy lung from a donor
How may you have to adjust your daily life to live with COPD?
Take prescribed medicine Stop smoking Exercise regularly Maintain healthy body weight Get vaccinated Check weather Watch what you breath (e.g. dust) Regular review and monitoring Breathing techniques Talk to others Money and financial support End of life care
What are comorbidities of COPD?
Cardiovascular Disease Diabetes and Metabolic Syndrome Osteoporosis Lung Cancer Depression Sleep Disorders Medication Reconciliation
What features might we see on a chest x-ray for someone with pneumonia?
Opacification
Loss of meniscus
What features might we see on a chest x-ray for someone with pleural effusion?
A large part of one lung now appears as opaque
What may an ABG show us?
low pH: acidemia
high pH: alkalemia
Low pH with high PCO2: Respiratory acidosis
Low pH with low HCO3: metabolic acidosis
High pH with low PCO2: respiratory alkalosis
High pH with high PCO2: metabolic alkalosis
What is type 1 respiratory failure?
Failure of lungs and heart to provide adequate O2 to meet metabolic need
What is type 2 respiratory failure?
Failure of lungs to eliminate adequate CO2
What is CPAP?
Continuous positive airway pressure
Receive the same amount of pressure as you breath in and out
Helps just with inhalation
Not used for COPD
What is BiPAP?
Bi-level positive airway pressure
Positive airway pressure received when you breath both in and out. Higher air pressure when you breath in.
Helps with inhalation and exhalation
Helps oxygenation and allows CO2 to be expelled
Used for COPD
What are causes of peripheral oedema?
- Alveolar hypoxia
- Hypoxic pulmonary vasoconstriction
- Pulmonary vascular resistance
- Pulmonary hypertension
- Right ventricular afterload
- Right ventricular failure
- Peripheral oedema
- Swelling of ankles and feet
What is cor pulmonale?
right-sided heart failure may develop due to pulmonary hypertension
blood can’t get backed up in the veins throughout your body
as fluid leaks into the surrounding tissues, oedema develops
due to the effects of gravity, fluid starts to pool in the lowest parts of your body -feet, ankles, and legs, making them swell
What is pulmonary hypertension?
occurs when lung disease causes high pressure in the blood vessels of the lungs
Therefore,the right side of your heart (which moves blood between the heart and lungs) has to work a lot harder to pump
