COPD Flashcards
What is COPD?
An inflammatory condition of the airways, lung parenchyma (functional tissues) and pulmonary vasculature. Causes airflow obstruction and respiratory symptoms.
What are the common symptoms of COPD?
Dyspnoea (breathlessness) and chronic productive cough (usually colourless sputum which may be green during LRTIs).
How is COPD diagnosed?
Presence of clinical features and spirometry.
What are the 2 spirometry tests done to diagnose COPD?
FEV1 and FVC.
Diagnosis of COPD - FEV1/FVC ratio of less than 0.7.
Diagnosis of stage: FEV1 compared to predicted value.
What is the order of treatment of COPD for individuals presenting with asthmatic features?
- SABA or SAMA prn
- LABA + ICS
- LABA + LAMA + ICS
What is the order of COPD treatment for individuals presenting with non-asthmatic features?
- SABA or SAMA prn
- LABA + LAMA
- LABA + LAMA + ICS
if successful carry on with step 3 but if not, go back to step 2.
Name 3 add on treatments for COPD. When would they be prescribed?
Oral corticosteroids - should only be used for exacerbations, not maintenance. If long-term required, monitor for osteoporosis and give appropriate prophylaxis.
Oral theophylline (slow release) - oral xanthine bronchodilator. Can be given after a trial of SABAs or LABAs. Monitor plasma levels and interactions.
Carbocisteine - oral mucolytic. Used in individuals with stable COPD and a chronic cough productive of sputum to help them cough up phlegm.
How do inhaled beta-2 agonists work?
Activate beta-2 receptors in the airways causing dilatation and smooth muscle relaxation.
Name 2 SABAs.
Salbutamol and terbutaline.
How long does it take SABAs to work?
Within 15 minutes.
Name 2 LABAs.
Salmeterol and formoterol.
What is the onset of action of LABAs?
Within 12 hours.
How should LABAs be prescribed?
In people regularly using ICS. Low dose at first then titrate up with monitoring.
When are beta-2 agonists contraindicated?
Hyperthyroidism - beta-2 agonists may stimulate thyroid activity.
Diabetes - rare risk of ketoacidosis but usually only with IV administration.
CVD - beta-2 agonists can cause arrythmias due to QT interval prolongation, as well as changes to BP and HR.
Which medicines are contraindicated/used with caution in COPD/asthma?
NSAIDs - can cause bronchospasm.
Opioids - can cause respiratory depression.
Beta-blockers - can interfere with beta-2 agonists and cause bronchoconstriction.
What are some common side effects of beta-2 agonists.
Headaches
Muscle cramps
Palpitations
Trembling
What is the mechanism of action of muscarinic antagonists?
Inhibit M3 muscarinic receptors in the airways to promote smooth muscle relaxation and bronchodilation.
Name one short-acting and one long-acting muscarinic antagonist.
SAMA - ipratropium.
LAMA - tiotropium.
What are muscarinic antagonists contraindicated in?
Glaucoma
Urinary outflow tract obstruction
Cystic fibrosis
What are some common side effects of muscarinic antagonists?
Cough
Constipation
Diarrhoea
Dry mouth
Headache
Narrow-angle glaucoma.
How do inhaled corticosteroids work?
Switch off activated inflammatory genes via histone deacetylation. This results in decreased formation of cytokines, decreased microvascular permeability, inhibited influx of eosinophils in the lungs, and reduced bronchial hyper-responsiveness.
Name 4 inhaled corticosteroids.
Beclomethasone
Budesonide
Fluticasone
Mometasone
What are some common side effects of ICSs?
Oral candidiasis (rinse mouth after use or use a spacer)
Headaches
Taste altered
Voice altered
Pneumonia in COPD patients
What is the goal of COPD treatment?
COPD cannot be cured, so the aim of treatment is symptom management.
What is the normal oxygen saturation levels of a healthy person and a person with COPD or respiratory failure?
Healthy: 95-100%
COPD/RF: 88-92%
