Clinical aspects and therapeutics of COPD Flashcards
What are the typical symptoms of COPD and similar respiratory diseases?
Cough
Sputum
Wheeze
Breathlessness
What things are very important when differentiating between these diseases when taking a history?
Smokers
Diurnal variation
Exacerbating factors
Family Hx
Allergies
Childhood atopy
What characteristics point to chronic bronchitis?
Smokers
Purulent sputum >= 3 months for >= 2 successive years
Type 2 respiratory failure - “Blue bloaters”
What characteristics point to emphysema?
Smoking history
Weight loss
Type 1 respiratory failure - “pink puffers”
Describe the characteristics of type 1 respiratory failure?
“Pink puffers”
- hyperinflated chest
- increased use of accessory muscles
- decreased sternal notch
- decreased chest expansion
- intercostal recession
- paradoixcal costal margin
- decreased hepatic/cardiac dullness
- heart sounds in epigastrium
- decreased breath sounds
- polyphonic wheeze
- scanty inspiration crackles
Describe type 2 respiratory failure
“Blue bloaters”
- bounding pulse
- flapping tremor
- cyanosis
- raised JVP
- ankle oedema
- tricuspid regurgitation
- large pulsatile liver
How will emphysema appear radiologically?
CXR will show decreased vascular lung markings
How is the diffusing capacity affected with emphysema?
Reduced due to destroyed capillary bed
Describe the FEV1 values at different severity levels according to NICE (2010) guidelines.
> = 80% - stage 1: mild
50 - 79% - stage 2: moderate
30 - 49% - stage 3: severe
< 30% - stage 4: very severe
How should COPD be managed?
With sensitivity - be careful using the word “emphysema”
Smoking cessation
Pharmacological methods
Pulmonary rehab
Managing acute exacerbations
What pharmacological therapies can be used to treat COPD?
Bronchodilators
Inhaled corticosteroids
Mucolytics
Vaccinations
What bronchodilators are available?
Beta 2 agonists
- SABA = salbutamol
- LABA = salmeterol
Muscarining-1 and muscarinic-3 antagonists
- SA =
- LA =
What are mucolytics used for?
Help clear mucus
Decrease need for antibiotics
Improves cough, dyspnoea, expectoration
Give an example of a mucolytic?
Carbocisteine
How do beta 2 receptors affect bronchi?
Cause bronchodilation
How do muscarinic Ach receptors affect bronchi?
Cause bronchoconstriction
Give examples of beta 2 agonists available to use against COPD?
SABA
- Salbutamol
- Terbutaline
LABA
- Salmeterol
- Formeterol
What are the side effects of beta-2 agonists?
Tremor
Hypokalaemia
Tachycardia
Give examples of muscarinic antagonists used for bronchodilation?
SAMA
- Ipratropium
LAMA
- Tiotropium
What are the side effects of Ipratropium?
Dry mouth
Blurred vision
GI disturbance
Can precipitate glaucoma in susceptible individuals
What are the side effects of Tiotropium?
Dry mouth
Irritation by powder in inhaler
What are the aims of pulmonary rehab?
Aims to break downward spiral of breathlessness and immobility
- improve QoL
- improve distance and speed of walking
How should an acute exacerbation be managed?
Start corticosteroids
Antibiotic therapy available in the house
