Chronic obstructive airway disease Flashcards
what are the two main features if COPD?
airflow obstruction and hyperinflation
what causes airflow obstruction?
chronic bronchitis
(airway lining sells up, airway muscles tighten, mucous builds up
what causes hyper inflation?
emphysema
is the airflow obstruction in COPD fully reversible?
no
how does airflow obstruction vary in COPD with asthma?
it is progressive on COPD and not fully reversible
why does COPD cause breathlessness?
the lungs are overinflated as some alveoli are hyper-inflated. these compress other alveoli. the hyper-inflated lungs push down on the diaphragm making it much harder to move it and breath. so sufferers take short, shallow breaths.
what causes the cough and recurrent chest infection in COPD?
the cilia mechanisms of sufferers of COPD are compromised. This means mucous builds up, causing coughing and also causes the inability to get rid of pathogens so infections are common.
what is the main reason that smoking causes COPD?
it contains nicotine and produces free radicals that cause tissue damage and an increase in neutrophil number, these neutrophils causes an increase in neutrophil elastase which also damages tissue. The free radicals also inactivate antiproteases (alpha one antitrypsin)
what is the form of COPD not caused by smoking?
congenital alpha one antitrypsin deficiancy
what are some non-respiratory effects of COPD?
-loss of muscle mass
-weigh loss
(two reasons above caused by increases use of energy for breathing)
-cardiac disease
-depression, anxiety etc
symptoms of COPD
age 35 or more current or former smoker – Chronic Cough – Exertional Breathlessness – Sputum production – Frequent “Winter” Bronchitis – Wheeze / chest tightness
how does COPD differ from asthma in terms of age of suffers?
COPD- greater than 35 (not congenital though)
asthma- all ages
how does COPD differ from asthma in terms of cough?
COPD-persistant and productive
asthma-intermittent and non-productive
how does COPD differ from asthma in terms of smoking?
COPD- almost invariable
asthma- possible
how does COPD differ from asthma in terms of breathlessness?
COPD-progressive and persistent
asthma- intermittent and variable
how does COPD differ from asthma in terms of nocturnal symptoms?
COPD- uncommon unless severe
asthma - common
how does COPD differ from asthma in terms of family history?
COPD- uncommon unless family members smoke
asthma - common
how does COPD differ from asthma in terms of concomitant eczema or allergic rhinitis?
COPD-possible
asthma- common
COPD on examination
– May be normal in early stages – Reduced chest expansion – Prolonged expiration/Wheeze – Hyperinflated chest – Respiratory failure • Tachypneoa • Cyanosis • Use of accessory muscles • Pursed lip breathing • Peripheral Oedema
what is the clinical history for COPD?
cough, breathlessness, chest infection, winter bronchitis
what is spirometry used for in COPD?
- confirms diagnosis
- assess severity
what does a FEV1/FVC less than 70% indicate?
an obstructive airway disease
an FEV1 of less than or equal to 80% is what severity of COPD?
mild
an FEV1 of 50-79% is what severity of COPD?
moderate
an FEV1 of 30-49% is what severity of COPD?
severe
an FEV1 less than 30% is what severity of COPD?
very severe
which baseline tests are used in COPD diagnosis and monitoring?
spirometry CXR ECG full blood count BMI AIAT- apha 1 antitrypsin test
what must be recorded with a respiratory test?
absolute and % predicted value to determine diagnosis or staging.
what is a CXR used for in COPD?
to check for other infections and also to see lung volume, if larger than normal and compressing heart then COPD
what can a full blood count be used for when dealing with COPD?
- to test for anaemia
- polycythaemia (high RBC count), occure with COPD
- eosinophilia, patient can be given immunosuppressive therapy
what can an AIAT be used for when dealing with COPD?
if alpha 1 antitrypsin levels are low then it may be due to a congenital COPD if age is less than 50
what are the possible complications of COPD?
- acute exacerbation
- pneumonia
- macro-nutrient deficiency
- wasting and muscle atrophy
- polycythemia
- pulmonary hypertenion
- cor pulmonale
- depression
- pneumothorax
how can progression of copd be prevented?
smoking cessation
how can breathlessness in copd be relieved?
inhalers
how can exacerbation of copd be prevented?
inhalers, vaccines, pulmonary rehabilitation
how can complication of copd be managed?
long term oxygen therapy
what are the non-pharmacological management techniques for copd?
Smoking Cessation • Vaccinations – Annual Flu vaccine – Pneumococcal vaccine • Pulmonary Rehabilitation • Nutritional assessment • Psychological support
what are the benefits of pharmacological management of copd?
– Relieve symptoms
– Prevent exacerbations
– Improve quality of life
what are the short acting bronchodilators for copd?
- SABA (short acting beta agonists) eg. salbutamol
- SAMA short acting muscarinic antagonists (eg- Ipratropium)
what are the long acting bronchodilators for copd?
– LAMA (Long acting anti – muscarinic agents, egUmeclidinium,
Tioptropium etc)
– LABA (Long acting B
2 agonist, eg- Salmeterol)
what are the high dose inhaled corticosteroids (ICS) and LABA treatments?
-Relvar (Fluticasone (ICS)/vilanterol (LABA))
– Fostair MDI
when should long term oxygen be given?
PaO2 <7.3kPa Or PaO2 7.3-8kPa if polycythaemia nocturnal hypoxia peripheral oedema pulmonary hypertension
what are the symptoms of acute exacerbation of copd?
- Increasing breathlessness
- Cough
- Sputum volume increase
- Sputum purulence
- Wheeze
- Chest tightness
- sputum colour change
which short acting bronchodilators are used in AECOPD?
-Salbutamol and/or Ipratropium
– Neubulisers if cannot use inhalers
which steroids are used in AECOPD?
Prednisolone 40 mg per day for 5-7 days
when are antibiotics used in AECOPD?
If there evidence of infection (fever, increase in volume/purulence of sputum)
when should AESOPD patients be admitted to hospital?
-Tachypneoa
– Low Oxygen saturation (< 90-92%)
– Hypotension etc
what are the investigations for patients admitted to hospital with AECOPD?
- full blood count
- biochemistry and glucose
- theophylline concentration (in patients using a theophylline preparation)
- arterial blood gas
- ECG
- CXR
- blood cultures in febrile pationts
- sputum microscopy, culture and sensitivity
what are the ward based management steps for patients with AECOPD?
• Oxygen- target Saturation 88-92% • Nebulised bronchodilators • Corticosteroids • Antibiotics (Oral Vs IV) • Assess for evidence of respiratory failure – Clinical – Arterial blood gas (ABG)
