COPD Flashcards
What is COPD?
Chronic obstructive pulmonary disease
-long term, progressive airway obstruction, chronic bronchitis and emphysema
What are some causes of COPD?
-smoking
-Alpha-1 antitrypsin deficiency
-industrial exposure e.g. soot
What are some symptoms of COPD?
Shortness of breath
Cough
Sputum production
Wheeze
Recurrent respiratory infections, particularly in winter
Whats the pathophysiology of COPD?
Mucous gland hyperplasia
Loss of cilial function
Emphysema - alveolar wall destruction causing irreversible enlargement of air spaces distal to the terminal bronchiole
Chronic inflammation (macrophages and neutrophils) and fibrosis of small airways
What is emphysema?
Damage and dilatation of alveolar sacs and alveoli
Decreases SA for gas exchange
What is chronic bronchitis?
Long term inflammation in the bronchi
Leads to cough and sputum production
What tool can be used to assess breathlessness?
The MRC Dyspnoea scale - 5 point scale
What are the 5 grades of the MRC dyspnoea scale?
Grade 1: Breathless on strenuous exercise
Grade 2: Breathless on walking uphill
Grade 3: Breathlessness that slows walking on the flat
Grade 4: Breathlessness stops them from walking more than 100 meters on the flat
Grade 5: Unable to leave the house due to breathlessness
How is the severity of COPD graded?
Graded using 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
How is COPD diagnosed?
Clinical presentation and spirometry results
What would the spirometry results be of someone with COPD?
obstructive picture with a FEV1:FVC ratio of less than 70%
little or no response to reversibility testing with beta-2 agonists
What are some other investigations done for suspected COPD and why?
-Body mass index at baseline (weight loss occurs in severe disease)
-Chest x-ray to exclude other pathology, such as lung cancer
-Full blood count for polycythaemia (raised haemoglobin due to chronic hypoxia), anaemia and infection
-Sputum culture to assess for chronic infections, such as pseudomonas
-ECG and echocardiogram to assess for heart failure and cor pulmonale
-CT thorax for alternative diagnoses such as fibrosis, cancer or bronchiectasis
-Serum alpha-1 antitrypsin to look for alpha-1 antitrypsin deficiency
-Transfer factor for carbon monoxide (TLCO) tests the diffusion of inhaled gas into the blood (reduced in COPD)
What are some long term management steps for COPD?
-Smoking cessation
-Annual flu vaccine and pneumococcal vaccine
-Pulmonary rehabilitation
What is the initial medical treatment for COPD?
Short-acting beta-2 agonists (e.g., salbutamol)
Short-acting muscarinic antagonists (e.g., ipratropium bromide)
Whats the second step of medical treatment for COPD?
If NO asthmatic or steroid response:
-Long-acting beta agonist (LABA)
-Long-acting muscarinic antagonist (LAMA) in combination
If asthmatic and steroid responsiveness:
-Long-acting beta agonist (LABA)
-Inhaled corticosteroid (ICS) combined (fostair)
Whats the final step of medical management of COPD?
a combination of a LABA, LAMA and ICS
Trimbow inhaler
What are some medical options for more severe COPD?
-Nebulisers (e.g., salbutamol or ipratropium)
-Oral theophylline
-Oral mucolytic therapy to break down sputum (e.g., carbocisteine)
-Prophylactic antibiotics (e.g., azithromycin)
-Oral corticosteroids (e.g., prednisolone)
-Oral phosphodiesterase-4 inhibitors (e.g., roflumilast)
-Long-term oxygen therapy at home
-Lung volume reduction surgery (removing damaged lung tissue to improve the function of healthier tissue)
-Palliative care (opiates and other drugs may be used to help breathlessness)
What precautions must be taken if patient is taking azithromycin?
Pt needs ECG and LFTs before and during treatment
