COPD Flashcards
how is COPD characterised?
life threatening lung disease
– Chronic
– Characterised by airflow obstruction
– Associated with an abnormal inflammatory response
– Not fully reversible
– Progressive i.e. worsens over time
define COPD
Characterised by airflow obstruction. The airflow obstruction is usually progressive, not fully reversible, and does not change markedly over several months.
Obstruction is due to a combination of airway and parenchymal damage. The damage is the result of chronic inflammation that differs from that seen in
asthma, and is usually the result of smoking.
who is COPD most common in?
65+
when is COPD slightly reversible?
when there is an element of asthma
can you get COPD if you never smoked?
yes- 12.2% have never smoked
what are the signs and symptoms of COPD?
- Exertional breathlessness
- Chronic cough
- Regular sputum production
- Frequent winter ‘bronchitis’
- Wheeze
- Chest tightness
- Fatigue
what are the possible complications of COPD?
- Cor pulmonale/heart failure
- Respiratory failure
- Sleep apnoea syndrome –prolonged
pauses in breath whilst asleep - Repeated respiratory infections particularly in the winter
- Osteoporosis
who do you consider a disgnosis of COPD with?
– Over 35 and
– Smokers or ex-smokers
– Have any of the symptoms
* Exertional breathlessness
* Chronic cough
* Regular sputum production
* Frequent winter bronchitis
* Wheeze
how would you diagnose someone without clinical symptoms of asthma?
– Chronic unproductive cough
– Significant variability in breathlessness
– Night time symptoms
– Significant diurnal or day to day variability in symptoms
what should a patient be asked about if COPD diagnosis should be considered?
– weight loss
– effort intolerance
– waking at night
– ankle swelling
– fatigue
– occupational hazards
– chest pain
– haemoptysis.
when do you preform a spirometry?
– at diagnosis
– to reconsider the diagnosis, for people who show an
exceptionally good response to treatment
– to monitor disease progression.
how do you confirm the diagnosis of COPD with spirometry
Measure post-bronchodilator spirometry to confirm the
diagnosis of COPD.
when s=would you think about alternative diagnosis in spirometry?
older people who have an FEV1/FVC ratio below 0.7 but do not have typical symptoms of COPD.
what would show a restrictive effect in spirometry?
– FVC is reduced and the FEV1/FVC ratio is >80%
– The lung volume is reduced and the FEV1 and FVC are reduced proportionately
when would spirometry show an obstructive effect?
Obstructive effect (e.g. asthma or COPD)
– FEV1 is reduced more than the FVC and the FEV1/FVC ratio is <80%
– FEV1 is less than 80% of predicted
– FVC can be near predicted
what additional investigations should be done at the time of initial diagnostic evaluation?
a chest radiograph to exclude other
pathologies
– a full blood count to identify anaemia or
polycythaemia
– BMI calculated.
what are the different measures on the dyspnoea scale?
1 Not troubled by breathlessness except on strenuous exercise
2 Short of breath when hurrying or walking up a slight hill
3 Walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace
4 Stops for breath after walking about 100m or after a few minutes on level ground
5 Too breathless to leave the house, or breathless when dressing or undressing
what are the aims of COPD management?
prevent symptoms and their recurrence
– Slow the progression of the disease
– Preserve optimal lung function (short and long term)
– Enhance quality of life
what advice is given to COPD patients?
– stop smoking
– comply with medication
– take regular exercise/pulmonary rehabilitation
– attend for a regular influenza vaccination, and
a (once-only) pneumococcal vaccination
what is offered in smoking cessation?
– NRT
– Varenicline
– Bupropion
what pharmacological management is there for COPD?
- Bronchodilators
– Beta2 receptor agonists, antimuscarinic
agents, theophylline - Corticosteroids
- Oxygen therapy
when would you consider neubuisers?
for people with distressing
or disabling breathlessness despite maximal therapy using inhalers.
when should you not continue nebulising therapy?
reduction in symptoms
– an increase in the ability to undertake activities of daily living
– an increase in exercise capacity
– an improvement in lung function
why is long term use of oral corticosteroids not recommended for patients with COPD?
side effects
* Monitor people who are having long-term oral corticosteroid therapy for osteoporosis, and give them appropriate prophylaxis. Start prophylaxis without monitoring for people over 65.
when should theophylline be given?
should only be used after a trial of short-
acting bronchodilators and long-acting bronchodilators, or for people who are unable to use inhaled therapy, as
plasma levels and interactions need to be monitored.
when should you reduce the dose of theophylline?
Reduce the dose of theophylline for people who are having an exacerbation if they are prescribed macrolide or fluoroquinolone antibiotics (or other drugs known to
interact).
when are oral mucolytics used?
or people with
a chronic cough productive of sputum.
what oral prophylactic antibiotics should be given with COPD?
azithromycin (usually 250 mg 3 times a week)
when should oral prophylactic antibiotics be given?
– do not smoke and
– have optimised non-pharmacological management and inhaled
therapies, relevant vaccinations and (if appropriate) have been
referred for pulmonary rehabilitation and
– continue to have 1 or more of the following, particularly if they
have significant daily sputum production:
– frequent (typically 4 or more per year) exacerbations with sputum
production
– prolonged exacerbations with sputum production
– exacerbations resulting in hospitalisation.
what is the purpose of monitoring oxygen saturation of arterial blood?
Used to monitor patients progress and during exacerbations
* SpO2
* Normal 97-99%
* Refer to specialist services if Sp02 <92% on
one or more occasion
what do the peripheral arterial chemoreceptors respond to?
respond to changes in CO2 and O2 and the pH of arterial blood. Afferents from the carotid body increase their rate of discharge significantly as PO2 falls
what do central chemoreceptors respond to?
respond to changes in the pH of the
CSF resulting from alterations in PCO2
* Increased PCO2 results in an increase in the PCO2 of the CSF and the hydration reaction for carbon dioxide is driven to the right:
CO2 + H2O ↔ H+ + HCO3-
* As a result, the pH falls in proportion to the rise in PCO2 and stimulates the chemoreceptors
when should you be cautious with oxygen in COPD?
some patients with COPD have reduced alveolar ventilation with a low Pa02 and a high PaC02. They may be cyanosed but not breathless. Their respiratory centres are relatively insensitive to C02 and they rely on hypoxic drive to maintain
respiration
when should emergency oxygen be used?
For most patients with known chronic obstructive pulmonary disease (COPD) or other known risk factors for hypercapnic respiratory failure (eg, morbid obesity, chest wall deformities or neuromuscular disorders), a target saturation
range of 88–92% is suggested pending the
availability of blood gas results.
why is the target for oxygen sat 88-92%?
In some people, uncontrolled oxygen therapy may reduce the depth and
frequency of breathing, leading to a rise in blood carbon dioxide levels and
a fall in the blood pH (acidosis). Controlled oxygen therapy must therefore
be administered by a delivery device and at a flow rate that helps the
oxygen saturation to be maintained between 88% and 92%.
define exacerbation
A sustained worsening of the patient’s symptoms from his or her usual stable state that is beyond normal day-to-day variation, and is acute in on set
what are the symptoms of exacerbation?
– Worsening breathlessness/dyspnoea
– Cough
– Increased sputum production/sputum volume
– Change in sputum colour
how does one self manage exacerbations?
Give people at risk of exacerbations a course of antibiotic and corticosteroid tablets to keep at home.
* Encourage people at risk of having an exacerbation to respond quickly to the symptoms of an exacerbation by:
– starting oral corticosteroid therapy (unless
contraindicated) if increased breathlessness
interferes with activities of daily living
– starting antibiotic therapy if their sputum is purulent
– adjusting bronchodilator therapy to control symptoms.
define pulmonary rehab
Pulmonary rehabilitation is defined as a multidisciplinary programme of care for patients with chronic respiratory
impairment that is individually tailored and designed to optimise each patient’s physical and social performance and autonomy.
what does pulmonary rehabilitation include?
– Multidisciplinary interventions
– Physical training
– Disease education
– Nutritional, psychological and behavioural intervention
