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Year 6 Respiratory > Chronic obstructive pulmonary disease > Flashcards

Chronic obstructive pulmonary disease Flashcards

1
Q

What are acute exacerbations of COPD?

A

Acute exacerbations of COPD are one of the most common reasons for hospital presentations in developed countries.

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2
Q

What are the most common infective causes of COPD exacerbations?

A

The most common infective causes are bacteria (Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis) and respiratory viruses (human rhinovirus is the most important).

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3
Q

What are the features of an acute exacerbation of COPD?

A

Features include an increase in dyspnoea, cough, wheeze, possible increase in sputum, hypoxia, and acute confusion.

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4
Q

What do NICE guidelines recommend for managing acute exacerbations of COPD?

A

NICE recommends increasing bronchodilator use, giving prednisolone 30 mg daily for 5 days, and considering antibiotics only if sputum is purulent or there are clinical signs of pneumonia.

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5
Q

What are the first-line oral antibiotics recommended by the BNF for COPD exacerbations?

A

First-line oral antibiotics include amoxicillin, clarithromycin, or doxycycline.

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6
Q

When is admission recommended for COPD exacerbations?

A

Admission is recommended for severe breathlessness, acute confusion, cyanosis, oxygen saturation less than 90%, social reasons, or significant comorbidity.

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7
Q

What is the target oxygen saturation for COPD patients at risk of hypercapnia?

A

The initial oxygen saturation target should be 88-92%.

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8
Q

What nebulised bronchodilators are used for COPD exacerbations?

A

Nebulised bronchodilators include beta adrenergic agonists (e.g., salbutamol) and muscarinic antagonists (e.g., ipratropium).

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9
Q

What is the typical use of non-invasive ventilation (NIV) in COPD patients?

A

NIV is used for COPD with respiratory acidosis, typically with pH 7.25-7.35, and requires greater monitoring if pH < 7.25.

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10
Q

What are the initial settings for bilevel positive airway pressure (BiPaP) in COPD?

A

Initial settings for BiPaP are EPAP: 4-5 cm H2O and IPAP: 10-15 cm H2O.

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11
Q

What is a major cause of COPD?

A

Smoking!

N/A

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12
Q

What genetic condition can lead to COPD?

A

Alpha-1 antitrypsin deficiency

N/A

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13
Q

Name some other causes of COPD.

A

Cadmium (used in smelting), coal, cotton, cement, grain

N/A

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14
Q

What does COPD stand for?

A

Chronic obstructive pulmonary disease

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15
Q

What are the older terms encompassed by COPD?

A

Chronic bronchitis and emphysema

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16
Q

What is the most common cause of COPD?

A

Smoking

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17
Q

What are some common features of COPD?

A

Cough (often productive), dyspnoea, wheeze, and in severe cases, right-sided heart failure resulting in peripheral oedema.

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18
Q

What investigations are recommended for suspected COPD?

A

Post-bronchodilator spirometry, chest x-ray, full blood count, and BMI calculation.

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19
Q

What does post-bronchodilator spirometry demonstrate in COPD?

A

Airflow obstruction with FEV1/FVC ratio less than 70%

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20
Q

What are the severity stages of COPD based on FEV1?

A

Stage 1 - Mild: FEV1 > 80%
Stage 2 - Moderate: FEV1 50-79%
Stage 3 - Severe: FEV1 30-49%
Stage 4 - Very severe: FEV1 < 30%

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21
Q

What is the value of measuring peak expiratory flow in COPD?

A

It is of limited value as it may underestimate the degree of airflow obstruction.

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22
Q

What is important to exclude when diagnosing COPD?

A

Lung cancer

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23
Q

What is the significance of the FEV1 in COPD diagnosis?

A

Symptoms should be present to diagnose COPD in patients with FEV1 > 80% predicted but post-bronchodilator FEV1/FVC < 0.7.

24
Q

What age group should be considered for a COPD diagnosis?

A

Patients over 35 years of age who are smokers or ex-smokers.

25
Q

What symptoms suggest a possible diagnosis of COPD?

A

Exertional breathlessness, chronic cough, or regular sputum production.

26
Q

What is the primary investigation for suspected COPD?

A

Post-bronchodilator spirometry to demonstrate airflow obstruction.

27
Q

What FEV1/FVC ratio indicates airflow obstruction in COPD?

A

FEV1/FVC ratio less than 70%.

28
Q

What findings might a chest x-ray show in COPD patients?

A

Hyperinflation, bullae, flat hemidiaphragm.

Also important to exclude lung cancer.

29
Q

What does a full blood count help to exclude in COPD diagnosis?

A

Secondary polycythaemia.

30
Q

Why is body mass index (BMI) calculated in COPD patients?

A

To assess overall health and nutritional status.

31
Q

How is the severity of COPD categorized?

A

Using the FEV1.

32
Q

COPD severity

A
33
Q

What do the 2018 NICE guidelines on COPD define regarding long-term oxygen therapy (LTOT)?

A

The guidelines define which patients should be assessed for and offered LTOT.

34
Q

How many hours a day should patients receiving LTOT breathe supplementary oxygen?

A

Patients should breathe supplementary oxygen for at least 15 hours a day.

35
Q

What equipment is used to provide a fixed supply for LTOT?

A

Oxygen concentrators are used to provide a fixed supply for LTOT.

36
Q

What conditions warrant assessment for LTOT?

A

Assessment should be considered for patients with very severe airflow obstruction (FEV1 < 30% predicted) or severe airflow obstruction (FEV1 30-49% predicted), cyanosis, polycythaemia, peripheral oedema, raised jugular venous pressure, or oxygen saturations ≤ 92% on room air.

37
Q

How is assessment for LTOT conducted?

A

Assessment is done by measuring arterial blood gases on 2 occasions at least 3 weeks apart in patients with stable COPD on optimal management.

38
Q

What pO2 levels indicate a patient should be offered LTOT?

A

Offer LTOT to 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, or pulmonary hypertension.

39
Q

What does NICE advise regarding smoking and LTOT?

A

Do not offer LTOT to people who continue to smoke despite being offered smoking cessation advice and treatment, and referral to specialist stop smoking services.

40
Q

What structured risk assessment should be carried out before offering LTOT?

A

A structured risk assessment should include the risks of falls from tripping over the equipment, the risks of burns and fires, and the increased risk of these for people who live in homes where someone smokes (including e-cigarettes).

41
Q

What did NICE update in 2018 regarding COPD?

A

NICE updated its guidelines on the management of chronic obstructive pulmonary disease (COPD).

42
Q

What is included in the general management of COPD?

A

Smoking cessation advice, annual influenza vaccination, one-off pneumococcal vaccination, and pulmonary rehabilitation for those who view themselves as functionally disabled by COPD.

43
Q

What is the first-line treatment for COPD?

A

A short-acting beta2-agonist (SABA) or short-acting muscarinic antagonist (SAMA).

44
Q

How does NICE determine if a patient has asthmatic features?

A

Criteria include previous diagnosis of asthma or atopy, higher blood eosinophil count, substantial variation in FEV1 over time, and substantial diurnal variation in peak expiratory flow.

45
Q

What does NICE say about formal reversibility testing?

A

NICE does not recommend routine spirometric reversibility testing as part of the diagnostic process or to plan initial therapy.

46
Q

What should be added if a patient has no asthmatic features?

A

Add a long-acting beta2-agonist (LABA) + long-acting muscarinic antagonist (LAMA).

47
Q

What is the recommended treatment for patients with asthmatic features?

A

LABA + inhaled corticosteroid (ICS), and if breathless or having exacerbations, offer triple therapy (LAMA + LABA + ICS).

48
Q

When is theophylline recommended by NICE?

A

After trials of short and long-acting bronchodilators or for those who cannot use inhaled therapy.

49
Q

What prerequisites are needed for azithromycin prophylaxis?

A

Patients should not smoke, have optimized standard treatments, and continue to have exacerbations, along with a CT thorax and sputum culture.

50
Q

What should patients with a history of exacerbations keep at home?

A

A short course of oral corticosteroids and oral antibiotics.

51
Q

When should mucolytics be considered?

A

In patients with a chronic productive cough and continued if symptoms improve.

52
Q

What do oral PDE-4 inhibitors do for COPD patients?

A

They reduce the risk of COPD exacerbations in patients with severe COPD and a history of frequent exacerbations.

53
Q

What are the features of cor pulmonale?

A

Peripheral oedema, raised jugular venous pressure, systolic parasternal heave, loud P2.

54
Q

What factors may improve survival in stable COPD patients?

A

Smoking cessation, long-term oxygen therapy, and lung volume reduction surgery in selected patients.

55
Q

NICE 2018 COPD guidelines flowchart

A
56
Q

COPD in over 16s: non-pharmacological management and inhaled therapies

A

Year 6 Respiratory (23 decks)

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