COPD Flashcards
What is COPD?
Non-reversible, long term deterioration in air flow through the lungs caused by damage to lung tissue
What are the two forms of COPD?
- Chronic bronchitis
- Emphysema
What does the damage to the lung tissue result in?
An obstruction to the flow of air through the airways making it more difficult to ventilate the lungs and making them prone to developing infections
What is the main cause of COPD?
Smoking
What is the typical presentation of COPD?
- cough: often productive
- dyspnoea
- wheeze
- Long term history of smoking
What are the main investigations for COPD?
Full blood count
BMI
Spirometry
Chest X-ray
What would you look for in a full blood of someone with suspected COPD?
Polycythaemia (too many RBC) or anaemia
What does polycythaemia a response to?
Chronic hypoxia
What might you see on a chest x-ray of someone with COPD?
- hyperinflation
- bullae
- flat hemidiaphragm
- lack of lung markings
- large central pulmonary arteries
What would postbronchodilator spirometry be in someone with COPD?
FEV1:FVC <70%
What is the diagnosis of COPD based on?
Clinical history and spirometry
What is the severity of COPD based of?
FEV1
What is stage 1 COPD?
FEV1 >80% predicted
Mild symptoms of COPD present
What is stage 2 COPD?
FEV1 50-79% predicted
Moderate
What is stage 3 COPD?
FEV1 30-49% predicted
Severe
What is stage 4 COPD?
FEV1 <30% predicted
Very severe
What is the general management of COPD?
smoking cessation advice
annual influenza vaccination
one-off pneumococcal vaccination
pulmonary rehabilitation
What is the first line management of COPD?
Bronchodilator therapy
What are the first line bronchodilators?
- short-acting beta2-agonist (SABA) or
- short-acting muscarinic antagonist (SAMA)-
What are examples of SABA inhalers?
Salbutamol
Terbutaline
What are examples of SAMA inhalers?
Ipratropium bromide
For patients who remain breathless or have exacerbations despite using short-acting bronchodilators, what is the next step dependent on?
Asthmatic features/features suggesting steroid responsiveness
No asthmatic features/features suggesting steroid responsiveness
What is the next step in the management of a patient with NO asthmatic features/features suggesting steroid responsiveness?
Add a long-acting beta2-agonist (LABA) + long-acting muscarinic antagonist (LAMA
What is the next step in the management of a patient with asthmatic features/features suggesting steroid responsiveness?
LABA + inhaled corticosteroid (ICS)
What is the management of a patient if they remain breathless or have exacerbations?
Offer triple therapy
What is triple therapy?
LAMA + LABA + ICS
What should you switch a SAMA to when adding a LAMA/LABA?
Switch to a SABA
When should oral theophylline be tried for someone with COPD?
Only after trying short and long-acting bronchodilators or for those who cannot used inhaled therapy
What oral antibiotic prophylactics could you give to someone with COPD?
Azithromycin
When might mucolytics be considered in a patient with COPD?
In patients with a chronic productive cough
When might long term oxygen therapy be considered?
- very severe airflow obstruction
- cyanosis
- polycythaemia
- peripheral oedema
- raised jugular venous pressure
- oxygen saturations less than or equal to 92% on room air
What level of airflow obstruction would indicate long term oxygen therapy?
FEV1 < 30% predicted
Who should long term oxygen therapy not be offered to?
people who smoke
What is emphysema?
Abnormal irreversible enlargement of the airspaces distal to the terminal bronchioles
Reduces the alveolar surface area thus impeding efficient gaseous exchange.
What is chronic bronchitis?
Chronic exposure to noxious particles causes hypersecretion of mucus in the large and small bronchi.
Airway inflammation and fibrotic changes result in narrowing of the airways and subsequently chronic airway obstruction.
What would suggest asthmatic features that would respond to steroids?
PMH of atopy or asthma
Eosinophilia
substantial variation in FEV1 over time (at least 400 ml)
Substantial diurnal variation in peak expiratory flow (20%)
What is the main cause of chronic bronchitis?
Smoking
What are the possible causes of emphysema?
Smoking
Alpha-1 antitrypsin
What are the requirements for long term antibiotic prophylaxis for COPD?
Patients should not smoke
Should have optimised standard treatments and continue to have exacerbations
What needs to be done before azaithromycin can be prescribed?
ECG to exclude QT prolongation should also be done as azithromycin can prolong the QT interval
What does a deficienct of Serum alpha-1 antitrypsin deficiency lead to?
Early onset and more severe disease
What would you find on -Pulse oximetry and ABG/VBG of someone with COPD?
↓PaCO2, hypercapnia
What is hypercapnia?
Presence of higher than normal level of carbon dioxide in the blood
What would you see on a CT thorax of someone with COPD?
Bronchial wall thickening
Scarring
What will the post-bronchodilator spirometry always stay at in someone with COPD?
It will always be <0.7
What might you see on an ECG and echo of someone with COPD?
Right atrial and ventricular hypertrophy
Why would you do a sputum culture in someone with COPD?
To check for infection
What are the features of Cor pulmonale in COPD?
Peripheral oedema
Raised jugular venous pressure
Systolic parasternal heave
Loud P2
What can be used in the management of cor pulmonale in COPD?
Loop diuretic for oedema, Consider long-term oxygen therapy
What can be used to improve surivival in someone with COPD?
smoking cessation
long term oxygen therapy
lung volume reduction surgery
When would LTOT be offered for someone with COPD?
2 result of pH <7.3
or
Those with a pO2 of 7.3 - 8 kPa and one of the following:
–secondary polycythaemia
–peripheral oedema
–pulmonary hypertension
