COPD Flashcards
What does COPD stand for and what conditions does it include?
COPD stands for Chronic Obstructive Pulmonary Disease and includes emphysema, chronic bronchitis, and refractory (non-reversible) asthma.
What are the key changes in the lungs in chronic bronchitis and emphysema?
In chronic bronchitis, there is inflammation, increased mucus, and oedema in the bronchi/bronchioles. In emphysema, the alveoli walls are destroyed, causing them to dilate.
What is the primary cause of COPD?
Smoking is the primary cause, but it can also be related to other environmental factors and genetics.
What is the significance of FEV1/FVC ratio in diagnosing COPD?
An FEV1/FVC ratio of less than 0.70 indicates obstructive lung disease and is diagnostic for COPD.
What key factors are considered in a full COPD assessment?
The degree of obstruction (spirometry results), the nature and magnitude of symptoms (mMRC and CAT scores), history of exacerbations, and presence of co-morbidities.
Name some common co-morbidities associated with COPD.
Cardiovascular disease, lung cancer, depression, anxiety, osteoporosis, and muscle weakness.
What are some key non-pharmacological strategies for managing stable COPD?
Smoking cessation, annual influenza and pneumococcal vaccinations, pulmonary rehabilitation, and maintaining physical activity.
What classes of inhaler medications are commonly used for stable COPD?
Short-acting bronchodilators (SABA), long-acting beta-agonists (LABA), long-acting muscarinic antagonists (LAMA), and inhaled corticosteroids (ICS).
Name two additional pharmacological strategies for COPD patients with persistent symptoms.
Mucolytics (e.g., carbocisteine) and selective phosphodiesterase-4 inhibitors (e.g., roflumilast).
What adjunct therapies might be considered for COPD management?
Anxiolytics, low-dose opiates for end-stage disease, nutritional supplements for low BMI, and long-term oxygen therapy.
What are common signs of an acute COPD exacerbation?
Increased breathlessness, wheeze, cough, increased sputum production, use of accessory muscles, new cyanosis, and acute confusion.
What is the first-line treatment for an acute exacerbation of COPD?
Increase the dose or frequency of SABA (via pMDI with a spacer or a nebuliser), and prescribe oral steroids (30mg prednisolone daily for 5 days).
When are antibiotics indicated during an acute COPD exacerbation?
When there are signs of bacterial infection, such as changes in sputum color, increased volume or thickness, raised WCC, or high CRP levels.
What target oxygen saturation (SpO2) is recommended for COPD patients at risk of CO2 retention?
The target is 88-92% to avoid hypercapnia
When should NIV be considered in COPD patients?
In cases of severe acidosis (PaCO2 >6 kPa, pH <7.26), severe dyspnoea with accessory muscle use, or persistent hypoxaemia despite oxygen therapy.
