COPD Flashcards
What is the mechanism of Roflumilast?
Oral phosphodiesterase inhibitor. Reduces moderate to severe exacerbations in patients with severe and very severe COPD
What is used to calculate BODE score
BMI
Obstruction (FEV1)
Dyspnea (mMRC)
Exercise tolerance (6 min walk test)
Gives probability of survival @ 52 months
A 66 year old man is diagnosed with COPD
His FEV1 is 62% predicted, FEV1/FVC 65%. What is the staging of severity?
Moderate
If FEV1/FVC is 0.7 there is obstruction. GOLD:
<30% very severe 4
31-50% severe 3
51-79% moderate 2
>80 mild 1
An 80 year old has recently been diagnosed with COPD. His FEV1/FVC is 55%. His FEV1 is 30% predicted, what is the severity?
Very severe -
If FEV1/FVC is 0.7 there is obstruction.
<30% very severe
31-50% severe
51-79% moderate
>80 mild
What is the leading cause of death in COPD?
-Respiratory failure
-Cardiovascular disease
-PE
-Lung cancer
-Pnuemonia
Cardiovascular disease ( this includes patients ranging from mild - severe COPD), followed by lung cancer.
Respiratory Failure in very severe COPD
Does LVRS improve mortality?
No
Improves ET, SOB, QOL
Which patients benefit from LVRS?
Those with hyperinflation RV>150% predicted, TLC >100% predicted
Heterogeneous
Upper lobe predominant
Greater degrees of inflation RV >200%
Low ET
What are the complications of LVRS?
Peri-operative death
Air leak
Pneumonia
Single most important vaccine for COPD
Influenza
RSV
Shingles
Pneumococcal
Pneumococcal - over to >65 and re consider every 5 years
Covers 32 strains.
Influenza - covers 3 strains
RSV - vaccine doesn’t exist
A 68 year old lady with COPD presents to clinic. She is breathless when walking up stairs but can keep up with contemporaries? What is her mMRC and MRC?
1 mMRC
2MRC
Breakdown
mMRC MRC
SOB strenuous exercise 0 1
Breathless on incline/up stairs 1 2
Slower than contemporaries/
stops on own 2 3
ET 100 yards 3 4
Too SOB to leave home/
when dressing 4 5
A chap has COPD. He comes to clinic SOB
FEV 1 is 60%. He is breathless walking on incline and he has had 1 exacerbation (community) in last 1 year. He current inhaler is a SABA. What inhaled therapy would you add?
ICS
ICS/LABA
ICS/LABA/LAMA
LABA/LAMA
LAMA
LABA/LAMA
See NICE:
Which patients should be considered for endobronchial valves?
-On maximal therapy (bronchodilators, completion of PR, having stopped smoking for 6 months)
- significant hyperinflation - minimum RV >150% but ERS recommends RV >175% an leads to better outcomes. An RV/TLC ratio of >55% is also required
- intact fissures with minimal collateral ventilation
-Heterogenous emphysema
Before procedure need to assess presence of collateral ventilation. A surrogate for this is CT scan
Patients also undergo V/Q SPECT to assess lung perfusion
A functional assessment for collateral ventilation is the chartis system, involving specifically designed balloon catheter with a flow sensor
What are the post procedure complications of endobronchial valve?
Tension pneumothorax and massive haemoptysis
COPD E 30% post valves
Pneumonia 7%
Valve expectoration , aspiration or migration within 90 days reported in 7%
Why is smoking cessation required prior to thoracic surgery?
Smoking increases risk of post operative pulmonary complications:
1. pneumonia
2. respiratory distress
3. atelectasis
4.air leak
5. bronchopleural fistulae
6. re-intubation
7. length of stay
Abstinence at least 4 weeks prior to surgery reduces risk of major pulmonary events
Indications for bullectomy
Bulla involving 30% or more of hemithorax
FEV1 40% predicted
No significant hypercapnia
