Chronic COPD Flashcards
What is COPD?
COPD is an umbrella term encompassing the older terms chronic bronchitis and emphysema.
What is the cause of COPD?
Smoking
What are the features of COPD?
- cough: often productive
- dyspnoea
- wheeze
- in severe cases, right-sided heart failure may develop resulting in peripheral oedema
What investigations confirm the diagnosis of COPD?
Spirometry:
FEV1/FVC ratio less than 70%
How is the severity of COPD graded?
Using spirometry FEV1 results:
- Mild Stage 1 >80% FEV1
- Moderate Stage 2 50-79% FEV1
- Severe Stage 3 30-49%
- Very severe stage 4 <30%
What is the management of stable COPD?
General:
- Smoking cessation
- Flu vaccine and pneumococcal vaccine
- pulmonary rehabilitation
Inhalers:
*1st line: SABA or SAMA
*2nd add in no asthmatic features
>add LABA + LAMA
*2nd add in if asthmatic features
>LABA + ICS
*3rd offer triple therapy
>LAMA, LABA, ICS
Consideration:
- Prophylactic abs
- Mucolytics if chronic productive cough
- long term oxygen therapy
What features should be assessed when considering a patient for long term oxygen therapy in COPD?
- Severe airflow obstruction FEV1 <30%
- Cyanosis
- Polycuthaemia
- peripheral oedema
- Raised JVP
- Oxygen sats less than 92% on room aim
How is the assessment completed for considering a patient with COPD for LTOT?
*Assessment is done by measuring arterial blood gases on 2 occasions at least 3 weeks apart in patients with stable COPD on optimal management
What features qualify a patient for LTOT?
*patients with a pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following:
secondary polycythaemia
peripheral oedema
pulmonary hypertension
What are some examples of mucolytics?
Carbocisteine
What are examples of SAMA (short acting muscarinic/anticholinergic agents)?
Ipratropium
