CLINICAL- COPD Flashcards
What is the main cause of COPD? How many pack years?
Smoking!
Need to smoke 20 cigarettes a day (1 pack) for 20 years: 1 x 20= 20 pack years
What are the typical clinical features of COPD?
Exertional Dyspnoea (posh term for breathlessness/ SOB)
Cough (chronic productive cough)
Sputum production (mucus cough ups)
Wheeze
Do the symptoms of COPD come and go?
No. This is a key difference to asthma.
The symptoms of COPD are Fixed, there all the time, the disease course is progressive.
Asthma: symptoms come and go: can be no symptoms until something triggers it
What is the key diagnostic tool we use to diagnose COPD?
Spirometry
Take a deep breath out into a machine
From this we can get the FEV1 (forced expiratory volume in 1 second) and FVC (Forced vital Capacity)
There is two types of defects: obstructive defect, restrictive defect
What is the obstructive defect seen in Spirometry?
Where FEV1/ FVC ratio is UNDER 70%
This would show it’s COPD or asthma as opposed to Restrictive Defect
What is the restrictive defect seen in spirometry??
Where both FEV1 and FVC are down
The FEV1/ FVC is normal or over 70% (under 70% with obstructive defect in COPD asthma)
Restrictive defect indicates LUNG FIBROSIS
Can you think of further complications COPD may lead to?
Abnormal BMI: patients are breathless and so have exercise limitations so may have a high BMI. Or could have a low BMI if they’re ill: may need nutritional supplements.
Anxiety and depression: especially in those most physically disabled.
Cor pulmonale: Pulmonary heart disease: enlargement and failure of the right side of the heart as a result of vascular resistance or high BP in the lungs. Patient may need oxygen and diuretics for this.
What two things can improve a COPD patients survival?
Oxygen (long term oxygen therapy)
Smoking cessation: can increase how long the COPD patient lives by stopping at any age- it’s never too late!
(Note: all the drugs used in COPD are for symptom control not to improve survival!)
Breathlessness and exercise limitation can be extremely distressing for COPD patients as it can really effect their day to day lives. What to patients find especially difficult?
Climbing stairs.
Can be very scary for patient as they get very out of breath.
The symptom we ideally want to control is patients breathlessness.
What short acting inhalers can we use In COPD to control symptoms of SOB?
Short acting bronchodilators;
Short acting Beta 2 agonists (SABAs): salbutamol, terbutaline
Short acting Muscarinic antagonist (SAMAs: Not seen in asthma) e.g. Ipratropium, atrovent
Use these as required to alleviate symptoms
What long acting inhalers can we use in COPD to control the Shortness of breath symptom?
Long acting bronchodilators:
Long acting Beta2 Agonists (e.g. Serevent, eformeterol, salmeterol, Formeterol)
Long acting Muscarinic antagonists (e.g. Tiotropium, glycopyronnium)
What combination inhalers can we use in COPD?
Inhaled corticosteroids (ICS) combined with a LABA
E.g. Seretide (fluticasone propionate ICS combined with salmeterol LABA)
Symbicort: Budesonide (ICS) combined with Formeterol (LABA)
We can add in an ICS if their FEV1 is below 50% and they’ve have 2 or more exacerbations in the past 12 months
What’s the vicious circle experienced by COPD patients??
They feel breathless —> they avoid any activities that make them feel breathless—-> they end up being less active—> their muscles become weaker and less efficient—-> they get more breathless
They need to do more exercise but they feel they can’t… This is where pulmonary rehabilitation comes in..
What is pulmonary rehabilitation??
Mostly patients with COPD that attend Patient education Exercise training Psychosocial support Advice on nutrition
After a patient with COPD has an exacerbation that causes a hospital admission, what is the chance of re-admission?
Around 40%
After a patients first severe COPD exacerbation they usually have them more frequent exacerbations to follow
