COPD Flashcards
What is COPD?
COPD is a non-reversible, long-term deterioration in airflow through the lungs caused by damage to lung tissue.
COPD patients are susceptible to exacerbations that worsen lung function. What triggers these exacerbations?
Infections (Infective Exacerbations)
What kind of patient presentations suggest COPD?
Long-term smoker presenting with chronic shortness of breath, cough, sputum production, wheeze and recurrent respiratory infections, particularly in winter
Differential diagnoses that can be considered while investigating COPD include
- lung cancer
- heart failure
- fibrosis
Does COPD cause clubbing?
No
Would you expect to see hemoptysis or chest pain among COPD patients?
It is unusual and should be further investigated
List out the MRC Dyspnoea scale grades from NICE
1 - Breathless on strenuous exercise
2 - Breathless on walking up hill
3 - Breathlessness that slows walking on the flat
4 - Stop to catch their breath after walking 100 meters on the flat
5 - Unable to leave the house due to breathlessness
How’d you diagnose COPD?
Clinical presentation and spirometry
The severity of airflow obstruction can be graded using FEV1. List the stages.
1 - FEV1 > 80% of predicted
2 - FEV1 50-79% of predicted
3 - FEV1 30-49% of predicted
4 - < 30% of predicted
Additional investigations that can be conducted to help with COPD diagnosis and management include:
- Chest X-Ray
- Full blood count
- Body Mass Index
- Sputum Culture
- ECG and echocardiogram
- CT Thorax
- Serum alpha-1-antitrypsin
- Transfer factor for carbon monoxide (TLCO)
What is the purpose of chest X-Ray in COPD diagnosis?
To exclude other pathology (i.e. lung cancer)
What is the purpose of full blood count in COPD diagnosis?
For polycythaemia or anaemia. Polycythaemia (raised haemoglobin) is a response to chronic hypoxia.
What is the purpose of BMI in COPD diagnosis?
Baseline to later assess weight loss (e.g. cancer or severe COPD) or weight gain (e.g. steroids)
What is the purpose of sputum culture in COPD diagnosis?
To assess for chronic infections such as pseudomonas
What is the purpose of CT thorax in COPD diagnosis?
Alternative diagnoses such as fibrosis, cancer, or bronchiectasis
What is the purpose of TLCO in COPD diagnosis?
Decreased in COPD. It can give an indication about the severity of the disease and may be increased in other conditions such as asthma
Step 1 of Long-term COPD management
Short-acting bronchodilators such as::
- Beta-2 agonists (salbutamol or terbutaline)
- Short-acting muscarinic (ipratropium bromide)
Step 2 of Long-term COPD management if the patient does not have asthmatic or steroid-responsive features
Combine LABA and LAMA (i.e. Anoro Ellipta, Ultibro Breezhaler, or DuaKlir Genuair)
Step 2 of Long-term COPD management if the patient has asthmatic or steroid-responsive features
Combine LABA and ICS (i.e. Fostair, Symbicort, or Seretide)
Step 2 of Long-term COPD management if the patient has asthmatic or steroid-responsive features and LABA + ICS does not work
Add LAMA to the LABA and ICS combination (i.e. Trimbo, or Trelegy Ellipta)
Long-term Management options for severe cases include
- Nebulizers (Salbutamol and/or ipratropium)
- Oral theophylline
- Oral mucolytic therapy to break down sputum (e.g. carbocisteine)
- Long term prophylactic antibiotics (e.g. azithromycin)
- Long term oxygen therapy at home
At which point of COPD is long-term oxygen therapy used?
During severe COPD that is causing problems such as chronic hypoxia, polycythaemia, cyanosis or heart failure secondary to pulmonary hypertension (cor pulmonale)
Why can you not use oxygen therapy when the patient is smoking?
Oxygen plus cigarettes is a fire hazard
An exacerbation of COPD presents as
acute worsening of symptoms such as cough, shortness of breath, sputum production and wheeze
