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Respiratory medicine > COPD > Flashcards

COPD Flashcards

1
Q

COPD : definition

A

umbrella term encompassing chronic bronchitis and emphysema

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2
Q

COPD : Clinical features

A
  • Smoker : main cause is smoking
  • Chronic cough
  • Exertion breathlessness
  • Regular sputum production
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3
Q

COPD : Diagnosis

A
  1. Post-bronchodilator spirometry to demonstrate airflow obstruction: FEV1/FVC ratio less than 70%, no improvement post bronchodilator
  2. Chest x-ray- hyperinflation, bullae, flat hemidiaphragm. Also important to exclude lung cancer
  3. Full blood count: exclude secondary polycythaemia
  4. Body mass index (BMI) calculation
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4
Q

COPD : Severity staging

A

The severity can be graded using the forced expiratory volume in 1 second (FEV1):

Stage 1 (mild): FEV1 more than 80% of predicted
Stage 2 (moderate): FEV1 50-79% of predicted
Stage 3 (severe): FEV1 30-49% of predicted
Stage 4 (very severe): FEV1 less than 30% of predicted

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5
Q

COPD : Management of Stable COPD : First line

A
  • SABA

or

  • SAMA
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6
Q

COPD : Management of Stable COPD : Second line

A

Assess for asthmatic features;
1. Previous diagnosis of asthma or atopy
1. Variation in FEV1 of more than 400mls
1. Diurnal variability in peak flow of more than 20%
1. Raised blood eosinophil count

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7
Q

COPD : Management of Stable COPD : Second line

A
  1. ? Asthmatic features are present : Prev asthma dx / variation in FEV1} likely to be steroid response
    i) *LAMA + ICS
    Fostair, Symbicort and Seretide are examples of LABA and ICS combination inhalers.
  2. No Asthmatic features
    * LABA + LAMA
    Anoro Ellipta, Ultibro Breezhaler and DuaKlir Genuair are examples of LABA and LAMA combination inhalers.
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8
Q

COPD : Management of Stable COPD : Third line

A

combination of a
LABA + LAMA + ICS

Combination inhalers : rimbow, Trelegy Ellipta

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9
Q

COPD : Medical therapies (4)

A
  1. Oral theophylline
  2. Oral prophylactic antibiotic therapy of Azithromycin
  3. Mucolytics
  4. Phosphodiesterase - 4 inhibitors e.g. Roflumilast
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10
Q

COPD : Frequent exacerbations

A

home supply of corticosteroids and antibiotics

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11
Q

COPD : Medical therapies : Prophylactic antibiotics

A

Azithromycin

Indications: patients who; are on optimised treatment but _continue to have exacerbations_ and are not smoking.

Prior to starting;
*CT Thorax- to exclude bronchiectasis
*Sputum culture- to exclude atypical infections and tuberculosis
*ECG -to r/o Q-T prolongation as Azithromycin can cause this
*LFTs- Azithromycin can be hepatotoxic

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12
Q

COPD : Medical therapies : Phosphodiesterase - 4 inhibitors

A

Roflumilast
* MOA : Reduces the risk of COPD exacerbations in patients with severe COPD and history of frequent exacerbations

  • Indication : FEV1<50% and 2> exacerbations in past year whilst on triple maximum therapy
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13
Q

COPD : LTOT : Indication

A

Offer LTOT if ABG shows any of the following

  1. PO2 < 7.3 kPa at room air

OR

  1. Pa O2 7.3 - 8.0
    +
    One of the following;
    * Pulmonary hypertension
    * Secondary polycythemia
    * Peripheral oedema
    (Ie - signs of chronic hypoxia or cor-pulmonale causing HF)
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14
Q

COPD : LTOT : Assessment

A
  • 2 or more ABGs at least 3 weeks apart
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15
Q

COPD exacerbation : most common causative organism

A
  • Haemophilius influenza - /Most common/
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16
Q

COPD exacerbation : Primary care management

A
  1. Increase frequency of bronchodilator use
  2. Steroid : 30mg prednisolone daily for 5 days
  3. Antibiotics :
    * Amoxicillin 500mg TDS for 5 days
    * Doxycyline 200mg Day 1 and 100mg OD for 5 days
17
Q

COPD exacerbation : Mx of acute exacerbation

A
  1. Oxygen therapy before ABG
    * Aim for 88 - 92 % due to high risk of hypercapnia in COPD
    * Via 28% Venturi mask at 4L/min
  2. Nebulised Bronchodilators
    * Nebulised Salbutamol - provides bronchodilator affect
    * Nebulised Ipratropium (SAMA) - provides anticholinergic effect
  3. Steroid therapy
    * IV Hydrocortisone or PO Prednisolone
18
Q

COPD exacerbation : Respiratory acidosis pathophysiology

A
  1. Severe bronchoconstriction secondary to exacerbation impairs the ability of the lungs to exhale CO2
  2. CO2 diffuses into the blood and makes it acidic
  3. Retention of CO2 also impairs gas exchange leading to hypoxia
19
Q

COPD exacerbation : Respiratory acidosis : clinical features

A
  1. Shortness of breath and Tachycardia
  2. Chest pain
  3. Confusion and Drowsiness: elevated CO2 levels impact brain function leading to cognitive impairment
  4. Muscle weakness and lethargy
  5. Cyanosis
20
Q

COPD exacerbation : Respiratory acidosis : Management

A

If patient develops respiratory acidosis -
pH 7.25 - 7.35

} COPD patients require NIV

21
Q

NIV : Definition

A

mechanical ventilation to a patient’s lungs through a mask without an ‘invasive’ tube (intubation)

22
Q

NIV : Indication

A

Used to improve oxygenation and ventilation in patients with acute or chronic respiratory failure.

23
Q

NIV : iPAP/ePAP definition

A
  • iPAP - inspiratory positive airway pressure when air is forced into the lungs
  • EPAP - expiratory positive airway pressure - pressure during expiration to prevent airway collapse and increase end tidal volume
24
Q

NIV : Contraindication

A
  1. Facial deformity or airway obstruction - prevents effective mask seal for ventilation
  2. Inadequate sedation or altered mental status- inability to tolerate mask
  3. Risk of aspiration or vomiting - NIV increases risk of aspiration and development of pneumonia
  4. Hypotension- worsens existing hypotension by reducing cardiac output
  5. Pneumothorox -High air pressure can worsen pleural damage and exacerbate a pneumothorax
25
Q

CPAP : Definition

A
  • Continous and constant pressure during both stages of the breathing cycle
  • Provides the same pressure during inhalation and exhalation
  • Continous pressure primarily - helps to keep the airways open and patent
26
Q

CPAP : Indication

A

Improve Hypoxaemia
* Sleep apnea which involves airway obstruction during sleep
* Congestive cardiac failure
* Acute Pulmonary oedema

27
Q

BiPAP : Definition

A
  • Delivers two distinct pressures during the breathing cycle
  • Higher pressure is used for inhalation - overcomes airway resistance, improves oxygenation
  • Lower pressure is used for exhalation - aids to exhale CO2
28
Q

BiPAP : Indication

A
  • Respiratory acidosis ; pH 7.35 or paCO2 >6 despite adequate treatment
  • COPD
  • Variable breathing patterns such as those with neuromuscular diseases or central sleep apnea.

Respiratory medicine (18 decks)

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