Chapter 3 - COPD Flashcards
What two diseases make up COPD?
Chronic bronchitis and emphysema
What is chronic bronchitis?
Narrowing of bronchioles due to inflammation and excess mucus build up.
Symptoms:
Chronic cough
Sputum production
(Diagnosis - cough and sputum production for at least 3 months in 2 consecutive years)
What is emphysema?
Loss of lung elasticity and alveolar membrane breakdown.
(Alveoli function to facilitate gas exchange. O2 from inhaled air diffuse through alveolar membrane and is then transported to tissues in the body)
What does FEV1 stand for?
Forced expiratory volume in 1 second
What does FVC stand for?
Forced vital capacity - (max volume of air that can be expelled from the lungs)
In COPD FEV1 is generally reduced or increased?
Reduced
In COPD do you expect FVC to be reduced, increased or stay normal?
Generally FVC is normal, may be slightly reduced
What are the predicted FEV1 % and their corresponding stages of COPD?
FEV1 > 80% is stage 1 COPD (mild)
FEV1 50-79% is stage 2 COPD (moderate)
FEV1 30-49% is stage 3 COPD (severe)
FEV1 < 30% is stage 4 COPD (very severe)
Which bacteria are frequently associated with exacerbations of COPD?
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
NICE CG recommends the use of which antibiotics for the treatment of exacerbations of COPD?
Amoxicillin - 500mg-1g TDS
Macrolides (e.g clarithromycin 250mg - 500mg BD)
Tetracyclines (e.g doxycycline 200mg stat, 100mg thereafter)
Choice of antibiotics and duration depend on local policies
What strength of Prednisolone is usually used for the treatment of COPD exacerbation?
30mg/ day for 7-14days
What CHM advice (July 2008) is there regarding the use of Fostair in comparison to traditional beclometasone inhalers?
Fostair - contains extra fine particles of beclometasone and is therefore more potent than traditional beclometasone CFC free inhalers. Dose of Fostair should be lower than traditional formulations
What is Fostair?
Beclometasone and formoterol
Can beclometasone CFC inhalers Qvar and Clenil be prescribed generically or must they be brand specific?
Brand specific - Qvar has extra fine particles of beclometasone and is much more potent than traditional beclometasone inhalers and Clenil (~ twice as potent)
As of July 2008 MHRA has advised that beclometasone inhalers should be prescribed by brand. Is this statement True or False
True
100micrograms of Qvar (beclometasone dipropionate) is equivalent to how many micrograms of the following:
1) generic beclometasone
2) budesonide
3) fluticasone
1+2) 200-250micrograms of generic beclometasone or budesonide
3) 100micrograms of fluticasone propionate
Which of the following brands are licensed for use in COPD?
Clenil modulite Qvar Fostair Budelin Novolizer Pulmicort Turbohaler DuoResp Spiromax Symbicort Turbohaler Alvesco Flixotide Evohaler Flutiform Seretide Relvar Elipta Anoro Elipta
Fostair (beclometasone + formoterol)
DuoResp Spiromax (budesonide + formoterol)
Symbicort (budesonide + formoterol)
Seretide (fluticasone + salmeterol)
Relvar Elipta (fluticasone + vilanterol)
Anoro Elipta (umeclinidium + vilanterol)
What is Step 1 therapy for the treatment of COPD (NICE + BNF)?
SABA and/or SAMA
What is Step 2 treatment for COPD (NICE + BNF)?
FEV1 >/= 50%:
LABA or LAMA (discontinue SAMA)
FEV1 < 50%:
LABA + ICS or LAMA
What is Step 3 for the treatment of COPD (NICE + BNF)?
If patient was on LABA alone previously (FEV1 >50%) add in ICS
Or
LABA + ICS and LAMA
Which LAMA is a twice daily dose?
Aclidinium bromide
Glycopyrronium bromide
Tiotropium bromide
Umeclinidium
Aclidinium bromide
What are the general side-effects of inhaled antimuscarinics?
‘Anticholinergic side effects’ - dry mouth, constipation, diarrhoea, headache, sinusitis
More uncommon: angle-closure glaucoma, blurred vision, dizziness, AF
What are the side effects associated with inhaled B2 agonists?
Fine tremor (particulary of hands), headaches, nervous tension, muscle cramps, palpitations.
High doses also associated with hypokalaemia and hyperglycaemia (more common with IV)
What is the duration of action of formoterol and salmeterol?
Approximately 12 hours
