COPD Flashcards
What is COPD characterised by?
By airflow obstruction.
Progressive not fully reversible - due to combination of airway disease and parenchymal damage.
Treatable not curable.
Caused by smoking.
What is an example of an airway disease?
Obstructive bronchiolitis.
What predominantly causes COPD?
Smoking
What are exacerbations?
Rapid and sustained worsening of symptoms beyond normal day to day variations.
How is airflow obstruction/limitation measured?
Spirometry
What is FEV1?
Forced expiratory volume.
- Maximum amount of air which can be forcibly blown out of the lungs in one second.
What is FVC?
Forced vital capacity.
- Amount of air which can be forcibly exhaled from the lungs after taking the deepest breath possible.
What is the ratio of FEV1/FVC indicative of?
Airflow obstruction.
For diagnosis of COPD: FEV1/FVC = less than 0.7.
Describe chronic bronchitis.
Term referring to cough and sputum production for at least 3 months in each of 2 consecutive years.
Describe emphysema.
Refers to destruction of gaseous exchange surfaces of lungs - alveoli.
What are two very common mental co-morbidities of COPD and why do these occur?
Depression and anxiety.
Due to progressive breathlessness - leads to mobility issues and patient becoming housebound. Appears to be a disability and impairs quality of life.
What are the risk factors of smoking in terms of risk of COPD?
Higher prevalence of respiratory symptoms and lung function abnormalities.
Greater annual decline in FEV1.
Greater mortality rate.
What would you suggest a smoker to do when diagnosed with COPD?
Smoking cessation
-best way to delay progression of COPD at all stages of disease.
What is the consequence in continuing smoking for a COPD patient?
Patients who continue to smoke will see a greater decline in FEV1 and they will lose lung function at a more rapid rate. Loss of function cannot be regained.
List risk factors other than smoking which can increase risk of developing COPD?
Genetics, age, gender, lung development, exposure to particles, socioeconomic status, asthma/bronchial hyperactivity.
How does genetics play a part in developing COPD?
Results from interaction between genes and environment.
Usually is a severe hereditary deficiency of Alpha-1 Antitrypsin = circulating inhibitor of serine proteases.
How does smoking during pregnancy result in COPD in the child’s later life?
Mother smoking while pregnant can result in reduced lung function later in life or childhood.
How does air pollution cause COPD?
Air pollution has huge impact on lung maturation and development and can be harmful to individuals with an existing lung condition.
How does socioeconomic status cause COPD?
Poverty increases risks – due to crowded households, lack of ventilation, indoor/outdoor pollution, poor nutrition, exposure to fumes, infections
What is lung parenchyma?
Functional lung tissue.
How does chronic inflammation result in pathological changes so the airways, lung parenchyma and pulmonary vasculature of blood vessels?
Chronic inflammation increases production of inflammatory cells. This results in structural changes - result of repeated injury and repair.
How does a COPD affected lung tissue look compared to healthy lung tissue?
Narrowing of airways and bronchioles and reduction in surfaces for gas exchange and absorption.
Define pathogenesis.
The manner of development of disease.
What physiological process causes phlegmy cough/ chronic productive cough?
Mucus hypersecretion.
What does ciliary dysfunction cause?
Results in abnormal mucocilliary clearance and difficulty in expectorating/coughing up phlegm.
What does airflow obstruction and hyperinflation cause?
Breathlessness and limited exercise capacity.
What does gas exchange abnormalities cause?
Arterial hypoxemia and hypercapnia.
What does pulmonary hypertension cause in advanced COPD?
Cor pulmonale.
What is cor pulmonale?
Condition which causes right side of heart to fail.
Explain how hyperinflation occurs nd the consequence of this during exercise?
The airways obstruction progressively traps air during expiration which results in hyperinflation at rest and dynamic hyperinflation during exercise. And this hyperinflation reduces the inspiratory capacity and therefore the functional residual capacity during exercise. This results in breathlessness and limited exercise capacity – typical of COPD.
What signs to look out on examination of patient suspected of COPD?
Cyanosis, hyperinflated chest, cachexia.
What 3 features indicates presence of cor pulmonale in COPD patients?
Pulmonary hypertension, raised jugular venous pressure, peripheral oedema.
What is Cachexia?
Weakness and wasting of body due to severe chronic illness.
What are atopic diseases?
Disease caused due to genetic tendency to develop allergic diseases e.g. allergic rhinitis.
What is the MRC dyspnoea scale?
This is a breathlessness scale which grades level of breathlessness on daily activities.
What does spirometry measure? And why is it used for diagnosis?
Measures volume of air patient is able to expel from lungs after maximal inspiration.
Required for confirmation of diagnosis of COPD.
What do the predicted normal values of spirometry depend on?
Person’s age, height, gender, ethnicity.
Use table of normal predicted values.
What is the advantage of using spirometry?
It is non-invasive and readily available.
How many readings of FEV1 and FVC should be taken using spirometry?
Always 3 consistent readings of each.
What is a healthy FEV1/FVC ratio in a patient without COPD?
Ratio of 0.7.
What is FEV1 value for patient with COPD?
For patient with COPD, FEV1 is usually less than 80% of the predicted normal value.
(FEC is also reduced but not as reduced as FEV1.)
What should be administered before performing spirometry?
Adequate dose of short-acting inhaled bronchodilator.
200mcg salbulamol OR 500mcg terbutaline through spacer device.
What are the goals of treatment/therapy for COPD?
Relieve symptoms.
Prevent disease progression.
Improve exercise tolerance and health status.
Prevent and treat exacerbations and any further complications.
Reduce mortality.
What are two ways of managing COPD?
Smoking cessation.
Vaccinations.
Describe smoking cessation and how it helps?
Most cost effective and clinically effective.
Slows decline of FEV1, COPD progression, reduce mortality.
Offer NRT, varenicline or bupropion (antidepressant) unless contraindicated.
What vaccinations are recommended for COPD patients and why are they important?
Influenza, pneumococcal, COVID-19.
Reduce rates of hospital admission and risk of death.
COPD an be managed by pulmonary rehabilitation. How?
Pulmonary rehab can improve shortness of breath, overall health status and exercise tolerance.
Rehab includes physical training, disease awareness, mental health programs and education on disease.
How should a prescriber choose an inhaled medication delivery system for patients?
Choose based on age, coordination and expiratory flow.
In what two conditions must a spacer device be used to deliver inhaled drug?
Used by all patients on high dose of ICS.
By elderly patients on any inhalers.
How do spacer devices work?
These slow down the particles of the drug and allow more time for evaporation of the propellent so that more of the drug can be inhaled. They increase the proportion of the drug delivered to the airway and they reduce the amount of drug deposited in the oropharynx, so reducing local adverse effects.
What are mucolytic drugs?
Mucolytic drugs facilitate expectoration by reducing the viscosity of sputum and can also reduce exacerbations.
Why would COPD patients be prescribed an antidepressant or anxiolytic?
Patients may suffer from anxiety and depression due to social isolation, symptoms and a declining ability to participate in day to day activities.
Anxiety and depression must be dealt with to prevent any further impairment on the patient’s quality of life.
Why would COPD patients be on nutritional supplements?
COPD can lead to significant weightloss.
A diuretic can be used to treat peripheral oedema in cor pulmonale. Name the drug and how it works.
Furosemide.
Treatment of cor pulmonale is aimed to treat the hypoxia and reduce the salt and water retention. Patients presenting with this conditions require oxygen therapy and the oedema associated with the condition can usually be controlled with careful diuretic therapy.
What can happen if patient is given inappropriate oxygen therapy?
Respiratory depression.
In what conditions relating to COPD should oxygen therapy be given/
- If having severe airflow obstruction (FEV1<30%)
- Cyanosis
- Polycythemia
- Peripheral oedema
- Increase in jugular venous pressure
- When oxygen saturations are less than or equal to 9.2% breathing air.
How much oxygen should be received by patient with COPD to obtain maximal benefit?
15 hours a day.
What are some reported symptoms for COPD exacerbations?
Worsening breathlessness Increased sputum volume and purulence Cough Wheeze Change in sputum colour
What is sputum with purulence?
Sputum contains pus - yellow/green in colour.
What tests must be done on patients presenting to hospital with exacerbations?
Chest X-Ray, ECG, full blood counts, sputum sample, blood cultures.
All needed to exclude any comorbidities.
What are some pharmacological management strategies for exacerbations?
Increased dose of short-acting bronchodilators.
Prednisolone 30mg for 5 days (if no C/I).
Antibiotic if exacerbation associated with infection.
IV theophylline if inadequate response to nebulised bronchodilators.
Oxygen given if necessary depending on O2 saturation.
How often should IV theophylline levels be monitored?
24 hours after initiation.
How often should there be a patient review for COPD mild/moderate/severe (stages 1-3)?
Annually
How often should there be a patient review for COPD very severe (stage 4)?
Twice a year
