COPD Flashcards
What is COPD?
chronic obstructive pulmonary disease
- characterised by persistent respiratory symptoms and airflow limitations
= due to airway and alveolar abnormalities
bronchoconstriction and mucus hyper secretion
What are the symptoms of COPD?
is a syndrome
- has a collection of signs and symptoms
chronic productive cough
- yellow, green sputum production
progressive dyspnoea
wheezing and chest tightness
limited exercise capacity
arterial hyperaemia with/without hypercapnia
pulmonary hypertension
systemic effects
- muscle wasting, osteoporosis, cardiovascular disease, fatigue, weight loss, depression, anorexia, anxiety, syncope, ankle swelling, rib fractures
How can COPD be investigated?
bloods
- FBC, U&Es, CRP
chest X-ray
spirometry
What is the pathophysiology of COPD?
emphysema
- abnormal enlargement of airspaces distal to terminal bronchioles due to destruction of bronchioles and alveoli
chronic bronchitis
- chronic inflammation associated with with hyper secretion of mucus
hyperinflation of lungs (>7 ribs seen on CXR), coarse bronchovascular markings and flattened diaphragm are signs
What are the assessment tools for COPD?
ABCD assessment tool
- uses FEV1 values
spirometry
- required for diagnosis
CAT assessment
modified MRC dyspnoea scale
What are pharmacological treatments for COPD?
bronchodilators
- SABA, SAMA, LABA (bd), uLABA (od), LAMA, theophylline
anti-inflammatory
- glucocorticoid (ICS or systemic), oral phosphodiesterase inhibitors
mucolytics
- carbocisteine
prophylactic antibiotic
- azithromycin
oxygen therapy
long term oxygen therapy
ambulatory oxygen
How can acute COPD exacerbation be treated?
oxygen and nebuliser
- salbutamol nebuliser
antibiotics
- azithromycin
steroids (oral or IV)
- oral prednisolone 30mg OD for 5 days, IV hydrocortisone 100 mg
What is the difference between asthma and COPD?
smokers
- COPD
chronic productive cough
- COPD
breathlessness
- COPD = chronic and progressive
- asthma = variable
nighttime waking with SOB or wheeze
- asthma
significant day to day variability of symptoms
- asthma
What are the types of SAMAs and LAMAs? How do they work? What are the adverse effects?
short acting muscarinic antagonists
- ipratropium
long acting muscarinic antagonists
- tiotropium, glycopyrronum, aclidinium
act on muscarinic receptors to cause bronchodilation
adverse effects
- dry mouth, cough, headache, dizziness, nausea, risk of acute angle closure glaucoma
What are the types of oral phosphodiesterase-4 inhibitors? How do they work? What are the adverse effects?
roflumilast
- blocking phosphodiesterase-4 leads to increased levels of cAMP which prevents airway inflammation and bronchoconstriction
What are the types of mucolytics? How do they work? What are the adverse effects?
carbocisteine, acetylcisteine
- reduces the viscosity of mucus
adverse effects
- skin reaction, GI bleeding
What are the types of prophylactic antibiotics used What are the adverse effects?
azithromycin
- is a macrolide
adverse effects
- tinnitus, hearing loss, cardiovascular effects (QT prolongation, ventricular tachycardia, tornadoes de pointes)
How is oxygen therapy used in COPD?
low concentration of 24-28% are used
- treats hypoxaemia not SOB
via venturi device at FiO2 28%
When is long term oxygen therapy needed?
patients with
- severe airflow obstruction = FEV1 < 30%
- cyanosis
- peripheral oedema
- raised jugular venous pressure
- oxygen saturations of 92% or less
What are the signs and symptoms of acute COPD exacerbation?
worsening dyspnoea
increased sputum volume
fever without obvious source
upper respiratory tract infection in the last 5 days
increased respiratory rate or heart rate increase 20% above baseline
severe exacerbation
- marked dyspnoea and tachypnoea
- pursed lip breathing or use of accessory muscles at rest
- new onset cyanosis or peripheral oedema
- acute confusion or drowsiness
- marked reduction in activates of daily living
