COPD Flashcards
What does COPD stand for, and the epidemiology of it in ireland?
chronic obstructive pulmonary disease
Studies in Europe estimate the prevalence of COPD to be approximately 10%, however it varies considerably between European countries.
—-Ireland has the highest rate of admissions for exacerbations of COPD in the Organisation for Economic Co-operation and Development (OECD) countries.
——COPD is more common in older people; European studies in people aged >70 years showed a prevalence of COPD of 20% in men and 15% in women.
What does COPD stand for, and the epidemiology of it in ireland?
chronic obstructive pulmonary disease
Studies in Europe estimate the prevalence of COPD to be approximately 10%, however it varies considerably between European countries.
—-Ireland has the highest rate of admissions for exacerbations of COPD in the Organisation for Economic Co-operation and Development (OECD) countries.
——COPD is more common in older people; European studies in people aged >70 years showed a prevalence of COPD of 20% in men and 15% in women.
what are the causes of COPD
Causes
• Cigarette smoking
• Genetic—bronchial hyperresponsiveness; α1-antitrypsin deficiency • Race—Chinese and Afro-Caribbeans have d susceptibility
• Diet—poor diet and low birthweight
what are the presenting symptoms of COPD
A diagnosis of COPD should be considered in patients over the age of 35 who have a risk factor (generally smoking) and who present with one or more of the following symptoms:
- -Exertional breathlessness
- -Chronic cough
- -Regular sputum production
Frequent winter ‘bronchitis’
Wheeze
what is the diagnosis for COPD
A diagnosis of COPD should be considered in patients over the age of 35 who have a risk factor (generally smoking, occupational exposure) and who present with one or more of the following symptoms:
- -Exertional breathlessness (dyspnoea)- dyspnea that is progressively getting worse, and persistent
- -Chronic cough-may be intermittend and may be unproductive
- -Regular sputum production- any pattern
The diagnosis of COPD is based on a combination
of history and physical examination with confirmation of the diagnosis using spirometry.
Diagnosis of COPD…
what fev/fev1 ratio for clinical diagnosis?
what FEV1 ?
% response to bronchodilator reversibility test?
less than 0.7
less than 70% predicted
less than 15% response
what are the causes of COPD
Causes
• Cigarette smoking
• Genetic—bronchial hyperresponsiveness; α1-antitrypsin deficiency • Race—Chinese and Afro-Caribbeans have d susceptibility
• Diet—poor diet and low birthweight
what are the presenting symptoms of COPD
A diagnosis of COPD should be considered in patients over the age of 35 who have a risk factor (generally smoking) and who present with one or more of the following symptoms:
- -Exertional breathlessness
- -Chronic cough
- -Regular sputum production
Frequent winter ‘bronchitis’
Wheeze
what is the diagnosis for COPD
A diagnosis of COPD should be considered in patients over the age of 35 who have a risk factor (generally smoking) and who present with one or more of the following symptoms:
- -Exertional breathlessness (dyspnoea)
- -Chronic cough
- -Regular sputum production
The diagnosis of COPD is based on a combination
of history and physical examination with confirmation of the diagnosis using spirometry.
what is spirometry? what does it measure.
Spirometry measures
—the volume of air forcibly exhaled from the point of maximal inspiration (FVC - forced vital capacity)
—-the volume of air exhaled during the 1st second of this manoeuvre (FEV1 forced expiratory volume in one second);
—-the ratio of these two measurements (FEV1/FVC) is calculated
what fev/fev1 ratio confirms COPD post bronchodilator?
less than
What investigations should be carried out to rule out other conditions that may be attributing to the COPD?
—–a chest x-ray to exclude other conditions such as lung cancer and tuberculosis.
—-serial peak flow measurements (to exclude asthma, which is frequently indistinguishable from COPD),
—–ECG and echocardiography (to assess cardiac status if there are clinical features of cor pulmonale)
—-and alpha-1 antitrypsin deficiency (if early onset, minimal smoking history or positive family history)
describe the MRC dyspnea scale? (used to provide an objective measure of breathlessness)
MRC dyspnoea scale
Grade Degree of breathlessness related to physical
activity
1 Not troubled by breathlessness, except on strenuous
exercise


2 Short of breath when hurrying or walking up a slight hill


3 Walks slower than contemporaries on level ground
because of breathlessness or has to stop for breath
when walking at own pace


4 Stops for breath after walking 100m or after a few
minutes on level ground


5 Too breathless to leave the house or breathless on
dressing/undressing
describe the classification system (GOLD) for COPD? (based on FEV1 values)
GOLD 1 Mild FEV1 ≥80% predicted
GOLD 2 Moderate 50%- 80% FEV1 predicted
GOLD 3 severe 30%-49% FEV1 predicted
GOLD 4 VERY severe less than 30% predicted
what are the 4 main goals of COPD management?
The main goals in the management of COPD are to improve the patient’s health by:
(1) reducing symptoms,
(2) reducing the rate of lung function decline,
(3) preventing exacerbations and
(4) reducing mortality
what are the signs of COPD?
Signs May be none. Possible signs:
• Hyperinflated chest ± poor chest expansion on inspiration • dec cricosternal distance • Hyperresonant chest with d cardiac dullness on percussion • Wheeze or quiet breath sounds • Paradoxical movement of lower ribs • Use of accessory muscles • Tachypnoea • Pursing of lips on expiration (purse lip breathing) • Peripheral oedema • Cyanosis • inc JVP • Cachexia
what is the DDX for COPD?
asthma, bronchiectesis, lung cancer, heart failure
compare COPD with asthma under these headings:
onset, smoking hx, breathlessness, chronic prod cough, waking at night with wheeze/cough
COPD ——>
onset opposite to all of above
Assessment of a patient with COPD is based on three things, what are they?
severity of airflow
severity of symptoms
risk of future exacerbations
how is the risk of exacerbation assessed?
by spirometry- this helps us classify according to the GOLD classification
by assessing the no of exacerbations in the past 12 months
non-pharm treatment of COPD?
Smoking cessation & nicotine replacement therapy
Patient education
exercise
pulmonary rehabilitation programmes
ambulatory oxygen therapy (AOT)
LTOT- long term administration of oxygen therapy
Non-invasive positive pressure ventilation (NIV)
other—
pollution- indoor and outdoor
occupational exposure
physical activity
what Pharmacotherapeutic agents should be offered to aid smoking cessation?
need to do this
what is LTOT?
what are the indications?
how beneficial is it?
Long-term administration of oxygen therapy (LTOT) (> 15 hours per day) in patients with chronic respiratory failure has been
shown to increase survival in patients with severe resting hypoxaemia.1,8 LTOT is indicated for patients who have a PaO2
≤7.3
kPa or a PaO2 of 7.3-8.0 kPa with evidence of pulmonary hypertension, peripheral oedema with congestive cardiac failure or
polycythaemia, when assessed on two separate occasions
what is NIV?
Non-invasive positive pressure ventilation (NIV) is increasingly being
used in patients with stable very severe COPD, who may have required assisted ventilation during an exacerbation
refers to positive pressure ventilation delivered through a noninvasive interface (nasal mask, facemask, or nasal plugs), rather than an invasive interface (endotracheal tube, tracheostomy).
