Chronic Obstructive Pulmonary Disease (COPD) Flashcards
What is COPD?
- Airflow obstruction
- Progressive
- Not fully reversible
Hyperinflation - Emphysema
Symptoms in COPD
- Breathlessness
- Cough and recurrent chest infection
What is the main reason people develop COPD?
Smoking - tobacco
What other effect can COPD have on the body apart from respiratory?
- Loss of muscle mass
- Weight loss
- Cardiac disease
- Depression, anxiety etc
How do you diagnose COPD?
- Relevant history (symptoms)
- Look for clinical signs
- Confirmation of diagnosis and assessment of severity
- Other relevant tests e.g. spirometry
Symptoms smokers may have for COPD
- Chronic cough
- Exertional breathlessness
- Sputum production
- Frequent “winter” bronchitis
- Wheeze/chest tightness
COPD mainly >35 years old
Examinations of COPD
- 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 FEV1 indicates COPD severity?
- > 80% predicted (mild)
- 50-79% predicted (moderate)
- 30-49% predicted (severe)
- <30% predicted (very severe)
Baseline tests for COPD
- Spirometry: record absolute and % predicted value
- Chest Xray
- ECG
- Full blood count (anaemic/ polycythaemic/ eosinophilia)
- BMI
- AIAT
Aims of COPD management
- Prevention of disease progression
- Relieve breathlessness
- Prevention of exacerbation
- Management of complications
Intervention methods for COPD management
- Smoking cessation
- Inhalers
- Inhalers, vaccines, pulmonary rehabilitation (PR)
- Long term oxygen therapy
What are non-pharmacological management methods for COPD?
- Smoking cessation
- Vaccinations: annual flu vaccine, pneumococcal vaccine
- Pulmonary rehabilitation (PR)
- Nutritional assessment
- Psychological support
Benefits of pharmacological management of COPD
- Relieves symptoms
- Prevent exacerbations
- Improve quality of life
Inhaled therapy - Short acting bronchodilators
- SABA (e.g. salbutamol)
- SAMA (e.g. ipratropium)
Inhaled therapy - Long acting bronchodilators
- LAMA (long acting anti-muscarinic agents e.g. umeclidinium, tioptropium)
- LABA (long acting B2 agonist e.g. salmeterol)
Inhaled therapy - High dose inhaled corticosteroids (ICS) and LABA
- Relvar (fluticasone/vilanterol)
- Fostair MDI
When is Long term oxygen (LTOT) used for COPD?
when PaO2 <7.3 kPa
or PaO2 7.3-8kPa if:
- polycythaemia
- nocturnal hypoxia
- peripheral oedema
- pulmonary hypertension
COPD - Exacerbation (AECOPD) symptoms
- Increasing breathlessness
- Cough
- Sputum volume
- Sputum purulence
- Wheeze
- Chest tightness
AECOPD - OP management methods
- Short acting bronchodilators: salbutamol and/or ipratropium, nebulisers if cannot use inhalers
- Steroids: prednisolone 40mg a day for 5-7 days
- Antibiotics: if there is evidence of infection
- Consider hospital admission if unwell: tachypneoa, low oxygen saturation, hypotensions.
AECOPD investigations required in patients admitted to hospital
- Full blood count
- Biochemistry and glucose
- Theophylline concentration
- Arterial blood gas
- Electrocardiograph
- Chest Xray
- Blood cultures in febrile patients
- Sputum microscopy, culture and sensitivity
AECOPD - ward based management methods
- Oxygen-target saturation 88-92%
- Nebulised bronchodilators
- Corticosteroids
- Antibiotics (Oral vs IV)
- Assess for evidence of respiratory failure
AECOPD - acute respiratory failure method
Non-invasive ventilation (NIV)
