COPD Flashcards
Presentation of COPD
Long term smoker with chronic SOB, cough, sputum, wheeze and recurrent respiratory infections
What is the MRC dyspnoea scale
5 point scale that NICE recommend for assessing the impact of their breathlessness
Two criteria to diagnose
Clinical presentation and spirometry
Results of spirometry
Obstructive picture - FEV1/FVC ratio <0.7
How can the severity of the airflow obstruction be graded
Using the FEV1 score
Investigations that may be necessary to help with diagnosis and management
Chest XR, FBC, BMI, sputum culture, ECG, ECHO, CT thorax, Serum alpha-1 antitrypsin, transfer factor for CO2
Step one of COPD management
Short acting bronchodilators - beta-2 agonists or short acting antimuscarinics
Eg of beta-2 agonist
Salbutamol or terbutaline
Eg of short acting antimuscarinics
Ipatropium bromide
Step two of COPD management if they do not have asthmatic or steroid responsive features
Combined long acting beta agonist and long acting muscarinic antagonist (LABA and LAMA)
Step two of COPD management if they do have asthmatic or steroid responsive features
Combined long acting beta agonist and inhaled corticosteroid
Step three of COPD management
Combination of LAMA, LABA and ICS
Eg of combination inhalers with LAMA and LABA
Anoro Ellipta, Ultibro breezhaler and Duakir genuair
Eg of combination inhalers with LABA and ICS
Fostair, Symbicort and Seretide
Eg of combination inhalers with LABA, LAMA and ICS
Trimbo and Trelegy Ellipta
Additional options for more severe COPD
Nebulisers, oral theophylline, oral mucolytic therapy, long term prophylactic ABx, long term O2 therapy
When is LTOT used
Severe COPD that is causing problems such as chronic hypoxia, polycythaemia, cyanosis or HF secondary to pulmonary hypertension
Presentation of exacerbation of COPD
Acute worsening of symptoms such as cough, SOB, sputum production, wheeze
What aid is used to deliver oxygen
Venturi mask
Medical treatments for exacerbations if they are well enough to be at home
Prednisolone, regular inhalers and home nebulisers and Abx
Where is the damage in COPD
Damage to the lung tissues causes an obstruction to the flow of air through the airways making it more difficult to ventilate the lungs
Management of acute exaccerbation of COPD
Airway, O2 sats, nebulisers, steroids and antibiotics if infection
\Indications for LTOT
Patients having PaO2 <7.3kPa on 2 readings 3 weeks apart and non-smokers. Or PaO2 7.3 - 8kPa and hypoxia, peripheral oedema and pulmonary HTN
What is stage 2 COPD
50-79% FEV1 predicted
What is stage 3 COPD
30-49% FEV1 predicted
What is stafe 4 COPD
<30% FEV1 predicted
