Case Study 1- Chronic Obstructive Pulmonary Disease (COPD) Flashcards
What is COPD?
Long term obstruction of the airways due to own muscle obstruction
What is chronic bronchitis?
Inflammation and excess mucous in the airways
Airflow limitation
What is emphysema distraction?
Parts of the lungs involving gas exchange such as the alveolar membrane breakdown
Causing breaking difficulties and shortness of breath
What are the symptoms of COPD?
Chronic productive cough
Persistent and productive breathlessness
Shortness of breath (dyspnea)
Excess sputum production
Persistent wheezing
Chest infections
How is COPD diagnosed?
Spirometry- where the FEV/FVC ratio is less that 0.7
Blood test: alpha-1-antitrypsin deficiency
Chest x-ray: lung cancer and chest infection
What is the aims of treatment
- reduce risk of exacerbation/ frequency of symptoms
- improve exercise tolerance
-improve quality of life
What is the initial (1st line) treatment for COPD?
Offer SABA or SAMA
What is the mechanism of action of a SABA and LABA ?
They’re beta-2-agonists
Therefore:
- Binds to beta 2 receptors in the smooth muscle
- This causes smooth muscle relaxation
- Which causes airways dilation
What are the common side effects associated with beta-2-agonists?
Tremors
Palpitations
Headache
Anxiety
Insomnia
What is the mechanism of action of a SAMA and LAMA?
They’re muscurinic antagonists
Therefore:
- Bind to M3 receptors in the smooth muscle
- This inhibits ACh from acting in the desert of
- ACh is responsible for the muscle constriction of smooth muscles
- Therefore blocking the receptor will reduce muscle constriction causing smooth muscle relaxation
- Opening up the airways
What are the common side effects of muscurinic antagonists?
Dry mouth
Constipation
Blurred vision
Tachycardia
Drowsiness
Urinary retention
What is the mechanism of action of ICS?
Binds to glucocorticoid receptors in the lungs
This reduces inflammation
Give an example of a Saba
Salbutamol
Give an example of a LABA
Tiotropium
Give an example of a LAMa
Salmeterol
Formeterol
Give an example of a SAMA
Iprotropium
Give an example of an ICS
Fostair
What lifestyle advice can be given to COPD patients
Exercise
Balanced diet to reduce risk of infection
Smoking cessation
Online resources and support groups
Vaccination
What if FVC?
Total amount of air yoy can breath out after taking a deep breath
What is FEV1?
The total amount of air breathed out after a second
When would an ICS be prescribed to a patient with COPD?
When SABA or SAMA has been prescribed and not managing symptoms effectively
If asthmatic feature or features suggestive steroid responsiveness are present
Consider an ICS
When should oral corticosteroids be used in COPD? Give an example of a corticosteroid used and it’s doses
When there is an exacerbation of COPD
Prednisolone 30mg daily for 5 days
When would we use antibiotics to treat COPD?
If there is a COPD exacerbation caused by a chest infection
What are the side effects associated with oral corticosteroids?
Increase appetite
Increases risk of infection (pneumonia)
Osteoporosis
Blood glucose effected
How can we identify anxiety and depression in patients with COPD?
Have severe breathlessness
Are hypoxia
Have been seen at or admitted to hospital with an exacerbation of COPD
In the the NICE guidelines
When are nebulisers used in COPD?
When there is an exacerbation of COPD
When should oral prednisone be given in patients with COPD?
When there is an exacerbation
Where there is an increased breathlessness that interfere with daily activities
What dose of salbutamol should be given in a oxygen driven nebuliser?
5mg given every 20-30mins or when required
Ventolin nebules given salbutamol sulfate per 1mg per 1ml
