COPD Flashcards
What investigations should be done to investigate COPD?
CXR to exclude other diagnoses
FBC - anaemia, polycythaemia
BMI
Spirometry - post bronchodilator!!!!
What are risk factors for COPD?
Tobacco smoking Occupational - mining, textiles Age - at least 35 Genetics - alpha1antitrypsin deficiency Urban - air pollution Childhood respiratory infections
What is the fev1 of mild COPD?
fev1 >80% predicted
Only diagnosed in the presence of symptoms
What is the fev1 of moderate COPD?
Fev1 between 50-79% of predicted
Symptoms usually progress, with SOBOE
What is the fev1 of severe COPD?
Fev1 between 30-49% of predicted
SOB limits patients daily activities, with exacerbations present
What is the fev1 of very severe COPD?
Fev1
What is the MRC dyspnoea scale?
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
What is the first step of management of COPD?
Short acting B2 agonist inhaler
(Use before breathless activity)
Or
Short acting muscarinic antagonist inhaler
- ipratropium
- SE- dry mouth, increased cardiovascular risk
What is the second step in COPD management if feV >50%
Long acting B2 agonist
- salmeterol
- taken every day!
Or
Long acting muscarinic antagonist
- stop SAMA!
- tiotropium
What is the second step of management of COPD if fev1 <50%?
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
What is the third step in COPD management?
LAMA + LABA + ICS
When is theophylline used in COPD management?
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
When should oxygen therapy be considered in COPD?
Assess for LTOT need if:
FEV1
How is LTOT need assessed?
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
How many hours of supplementary oxygen is recommended for LTOT?
15 hours at least
If hypercapnoeic or acidosis on LTOT, refer to specialist care on NIV