COPD Flashcards
definition of COPD
persistent respiratory symptoms and airflow limitation
due to airway and/or alveolar abnormalities
usually caused by significant exposure to noxious particles
common symptoms of COPD
Dyspnea
= Progressive/ worsens over time
= Worse with exercise
= Persistent
Chronic cough +/- sputum production
= May be intermittent
Recurrent wheeze
= Present throughout the day, seldom nocturnal only
Chronic sputum production
main risk factors for COPD
Tobacco smoking
Indoor air pollution – burning wood/coals
Outdoor air pollution – vehicles
Occupational exposures – dust, chemical agents (petrol, aerosol)
Genetic
Old age
diagnosis for COPD
Symptoms (see S/S)
Risk factors (see RF)
Spirometry (objective measure of airflow limitation)
FEV1/FVC <0.7 = confirms airflow limitation (asthma/ COPD)
difference between COPD and asthma
chronic vs variable
persistent airflow limitation
hx of tobacco smoke
SE of LAMA
dry mouth
mechanism of LAMA
bronchodilation via inhibition of the muscarinic receptor on the airway smooth muscle
assessemnt of severity of COPD base d on what tests?
Modified British Medical Research Council (mMRC) Questionnaire
Breathlessness measurement: severity of SOB
Scale of 0-4
0 = least symptoms; breathless only with strenuous exercise
4 = too breathless to leave house; breathless even when dressing
COPD Assessment Test (CAT)
8‐item measure of health status impairment in COPD
Scale of 0-40 (higher = more severe)
<10 is low impact on life
≥10 consider regular tx for sx
>30 is high impact on life; can barely leave house
risk A group GOLD 2023 classification and tx
mMRC 0-1, CAT <10
0 or 1 exacerbations (not leading to hospital admission)
LAMA or LABA
with rescue SABA/SAMA
risk B group GOLD 2023 classification and tx
mMRC ≥2, CAT ≥10
0 or 1 exacerbations (not leading to hospital admission)
LAMA + LABA
with rescue SABA/SAMA
risk E group GOLD 2023 classification and tx
≥2 exacerbations or ≥ 1 leading to hospital admission
LABA + LAMA or
ICS + LABA + LAMA* (if EOS ≥300)
with rescue SABA/SAMA
non phx for COPD
Physical activity
Smoking Cessation
Vaccinations
Flu, Pneumococcal (PCV13/15/20, PPSV23), Pertussis, COVID-19, Shingles/ Zoster (for COPD adults ≥50yo), RSV
(if group B and E, include:)
Pulmonary rehabilitation
- Pt education on disease, tx options
- Exercise training
- Nutritional support (often underweight and muscle wasting)
- Psychosocial support (to overcome social isolation & depression)
monitoring for COPD
Monitor: decline in FEV1, sx, exacerbations
Check :
= Inhaler technique
= Adherence
= Smoking status and continued exposure to risk factors
= Encourage non-pharm (eg increase physical activity)
Referral for pulmonary rehabilitation
Review of need for:
Oxygen therapy
Ventilatory support
Lung volume reduction
Palliative approaches
Update action plan
dose of SABA in COPD
salbutamol
Ventolin MDI
2puff PRN
dose of SAMA in COPD
ipatropium
2puff TDS - QDS
dose of LABA in COPD
formoterol (atimos 12mcg)
1-2puff BD
dose of LAMAs in COPD
tiotropium (Spiriva 2.5mcg) = 2puff OD
umeclidinium (Incruse Ellipta 62.5mcg) = 1 inhalation OD
combination doses for COPD
Umeclidinium/ Vilanterol (Anoro Ellipta 62.5/25) = 1 puff OD
Glycopyrronium/ Indacaterol (Ultibro Breezhaler 50/110) = 1 cap OD
Tiotropium/ Olodaterol (Spiolto Respimat 2.5/2.5) = 2 puff OD
Fluticasone propionate/ Salmeterol (Seretide Accuhaler DPI – 500/50) = 1 puff BD
Fluticasone furoate/ Vilanterol (Relvar Ellipta 100/25) = 1 puff OD
GOLD categorisation in COPD
GOLD
FEV1 =
1 = >80
2 = 50-79
3 = 30-40
4 = <30
lab parameters to consdier for diagnosis of COPD
chest x ray to exclude (not useful to diagnose COPD)
CT scan
- for emphysema and lung nodules, airway abnormalities
alpha 1 antitrypsin deficiency (significant genetic risk factor)
blood EOS count
follow up phx management for patients?
1) acute dyspnea
eg persistent breathlessness or exercise limitation
step up according to class a > b > e
2) acute exacerbations
eg persistent exacerbations
LAMA/LABA > LABA + LAMA
> add ICS (if EOS >100) > add dupilumab If EOS>300)
OR
azithromycin (250mg/day or 500mg 3x/week x 1 year)
OR
roflumilast (not in sg)
management of COPD exacerbations
assess sx, chest radiograph, blood gases
supplemental oxygen
bronchodilators (short acting first then long acting when stable)
OCS
oral abx if infection present
non invasive ventilation
