COPD Flashcards

0
Q

What investigations should be done to investigate COPD?

A

CXR to exclude other diagnoses
FBC - anaemia, polycythaemia
BMI
Spirometry - post bronchodilator!!!!

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1
Q

What are risk factors for COPD?

A
Tobacco smoking
Occupational - mining, textiles
Age - at least 35
Genetics - alpha1antitrypsin deficiency
Urban - air pollution
Childhood respiratory infections
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2
Q

What is the fev1 of mild COPD?

A

fev1 >80% predicted

Only diagnosed in the presence of symptoms

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3
Q

What is the fev1 of moderate COPD?

A

Fev1 between 50-79% of predicted

Symptoms usually progress, with SOBOE

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4
Q

What is the fev1 of severe COPD?

A

Fev1 between 30-49% of predicted

SOB limits patients daily activities, with exacerbations present

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5
Q

What is the fev1 of very severe COPD?

A

Fev1

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6
Q

What is the MRC dyspnoea scale?

A

1 - no SOB except on hard exercise

2 - SOB on slight gradient

3 - walks slowly on flat ground due to SOB, or has to stop to catch breath

4 - stops for breath after 100m on flat

5- too breathless to leave house or when dressing or undressing

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7
Q

What is the first step of management of COPD?

A

Short acting B2 agonist inhaler
(Use before breathless activity)

Or

Short acting muscarinic antagonist inhaler

  • ipratropium
  • SE- dry mouth, increased cardiovascular risk
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8
Q

What is the second step in COPD management if feV >50%

A

Long acting B2 agonist

  • salmeterol
  • taken every day!

Or

Long acting muscarinic antagonist

  • stop SAMA!
  • tiotropium
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9
Q

What is the second step of management of COPD if fev1 <50%?

A

Long acting B2 agonist and ICS in a combination inhaler

  • ICS must always be given with lama!
  • eg fluticasone

Or

Long acting muscarinic antagonist
- stop SAMA

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10
Q

What is the third step in COPD management?

A

LAMA + LABA + ICS

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11
Q

When is theophylline used in COPD management?

A

For those who cannot use inhaled therapy

Can be used with B2 agonists and muscarinic antagonists

Requires monitoring - three days after starting, three days after dose adjustment

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12
Q

When should oxygen therapy be considered in COPD?

A

Assess for LTOT need if:

FEV1

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13
Q

How is LTOT need assessed?

A

Measure ABG on two occasions, at least three weeks apart

Consider if PaO2 is <7.3 KPa when stable

Or

If PaO2 is between 7.4 and 8 KPa when stable and secondary polycythaemia, nocturnal hypoxaemia or oedema and pulmonary hypertension

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14
Q

How many hours of supplementary oxygen is recommended for LTOT?

A

15 hours at least

If hypercapnoeic or acidosis on LTOT, refer to specialist care on NIV

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15
Q

What is involved in pulmonary rehabilitation?

A

Community based programme
8 week rolling programme
Patients bussed to and from sessions

May prevent need for LTOT

Combines education, breathing training, cheat physio, respiratory muscle training, nutrition counselling and psychological support

Offer to all who consider themselves disabled - MRC grade three and above

NOT offered if cannot walk, unstable angina, and recent MI

16
Q

How often are patients with COPD reviewed, and what is covered?

A

At least once a year - twice if severe

Vaccinations - pneumococcal and flu jab

Smoking status
Symptom control
Medication review
Inhaler technique
Spirometry
BMI
MRC dyspnoea score
Review complications
Review need for LTOT
17
Q

What lifestyle advice an be given to people with COPD?

A

Smoking cessation
Exercise and weight reduction
Learning breathing exercises
Adherence to medication - prevents flare ups
Flu and pneumococcal jab
Avoid exposure to dust, irritants, aerosols
Check weather - avoid going out in cold/humid weather

18
Q

How does acute exacerbation of COPD present?

A
Worsening breathlessness
Cough
Increased sputum
Change in sputum colour
Fatigue
Fluid retention
Confusion
Tachpnoea
19
Q

What investigations should be considers in acute exacerbation of COPD?

A
FBC 
UandEs
Sputum culture
CXR
ECG
20
Q

How is acute exacerbation of COPD managed?

A

Oral prednisolone 30mg daily for 7-14 days
High dose short acting bronchodilator
Antibiotics only if sputum is pure lent or signs of infection- send for sputum culture

Reduce frequency of exacerbation by improving management
Oxygen therapy or positive pressure ventilation may be necessary