COPD Flashcards
What is COPD?
Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, refractory (non-reversible) asthma, and some forms of bronchiectasis. This disease is characterized by increasing breathlessness.
What is the main cause of COPD?
Smoking
What are the causes of COPD?
Smoking
Pollution and fumes - in very polluted areas/countries.
At diagnosis, what % of lung function is already lost in COPD?
20-30%
What drives COPD forward, in terms of disease progression?
Infections/exacerbations cause COPD to become more severe overtime.
Outline the main clinical features of COPD
Exertional dysponea
Cough
Sputum production
Wheeze
What is dysponea?
Difficulty breathing (usually upon exertion in COPD)
What are common misdiagnosis of COPD?
Asthma, bronchiectasis, lung cancer
How can stopping smoking help patients with COPD?
If you stop smoking at any point your lung function will go back to decreasing at the rate of a non-smoker
Why do we only use ICS/LABA combination inhalers as third line treatment?
ICS/LABA inhalers have been associated with increase risk of pneumonia.
what is meant by an acute exacerbation of copd? What sort of symptoms might a patient be experiencing?
A sustained worsening of the patients condition, from the stable state and beyond normal day to day variations.
Increased SOB, worsening cough, increased sputum production, change in sputum colour.
What two vaccinations should be recommended to people with COPD?
One off pneumococcal and annual influenza
How should an acute exacerbation of COPD be managed?
- Bronchodilator - salbutamol 2.5mg 4 hrly and ipratropium 500ugm qds
- Steroids - prednisolone 30mg 7-10 days
- Antibiotics - if consolidation on CXR treat as pneumonia
VTE prophylaxis
Consider carbocisteine.
What are the oxygen target sats in COPD?
88-92% lower than normal
Do steroid doses need to be tapered after an acute COPD attack?
Usually no need for tapering dose as only for 7-10 days.
How can you calculate a patients number of pack years?
Number of cigarettes smoked per day / 20 and multiplied by the number of years smoked
What age is COPD generally seen in?
Over 40 years
Why do patients with COPD have lower oxygen sats targets?
At risk of hypercapnic drive leading to respiratory depression
A FEV1 reading of 60-80% indicates what about COPD severity?
Mild severity
A FEV1 reading of 40-59% indicates what about COPD severity?
moderate
A FEV1 reading of <40% indicates what about COPD severity?
severe
An FEV1 reading of 35% means what in terms of COPD severity?
Severe COPD
What should nebulisers be driven with in COPD?
Drive all nebulisers with AIR (not oxygen to avoid worsening hypercapnia)
When should steroids be taken?
In the morning
Steroids should be taken for 7-14 days, what determines the length of the course?
The length of the course is decided by the severity, patient response and they have had for previous exacerbatios.
When should pulmonary rehabilitation be offered to patients with COPD?
Pulmonary rehabilitation should be made avaliable to all patients with COPD who have had a recent hospitalisation for an acute exacerabtion
How can further COPD exacerbations be minimised?
Steroid rescue pack
Stop smoking
Vacinaations
In people with stable COPD and an FEV1 >50% who remain breathless or have exacerbations despite maintenance therapy with a LABA, what should be offered?
Consider LABA+ICS combination inhaler
Consider LAMA in addition to LABA where ICS is declined or not tolerated
In patients with stable COPD who remain breathless or have exacerbations despite using a SABA as required, what should be offered as additional maintenance therapy?
If FEV1 >50% predicted: either a LABA or LAMA
If FEV1 <50% predicted : either LABA/ICS combination or LAMA
When should oral mucolytic therapy be considered? For how should it be used?
Mucolytic therapy should be considered in patients with a chronic cough productive of sputum. Should be continued if there is symptomatic improvement.
Should oral prophylactic therapy be given to patients with COPD to prevent exacerbations?
No - there is insufficient evidence to recommend prophylactic antibiotic therapy in the management of COPD
Inappropriate oxygen therapy in people with COPD may cause what?
Respiratory depression
When is long term oxygen therapy indicated in patients with COPD?
LTOT is indicated in patients with COPD who have a PaO2 less than 7.3kPa when stable or a PaO2 greater than 7.3 and less than 8kPa when stable and one of: secondary polycythaemia, nocturnal hypoxemia, peripheral oedema or pulmonary hypertension.
To get the benefits of LTOT patients should breathe supplemental oxygen for how many hours per day?
At least 15 hours per day - greater benefits are seen in patients receiving oxygen for 20 hours per day.
What is pulmonary rehabilitation?
Pulmonary rehabilitation is defined as a multidisciplinary programme of care for patients with chronic respiratory impairment that is individually tailored and designed to optimise each patient’s physical and social performance and autonomy.
Outline pallative care in COPD patients
Opioids should be used when appropriate to palliate breathlessness in patients with end-stage COPD which is unresponsive to other medical therapy.
How often should patients COPD be reviewed/followed up?
Patients with COPD should be reviewed at least once per year - more frequently if needed (if severe disease should be seen at least twice a year)
What should a follow up with a COPD patient entail?
Smoking status and smoking cessation advice
Adequacy of symptom control - breathlessness, exercise tolerance, estimated exacerbation frequency
Presence of complications
effects on each drug treatment
inhaler technique
need for referral to a specialist?
need for pulmonary rehabiliatation
Measurements to make: FEV1 and FVC, BMI, MRC dyspnoea score
What steroids should be given for an acute exacerbation of COPD?
Prednisolone 30mg orally for 7 to 14 days.
What should be considered in patients requiring frequent courses of oral corticosteroids?
Osteoporosis prophylaxis
You have a query from a doctor, they ask whether ICS therapy will actually improve their patients lung function. How do you respond?
Inhaled corticosteroid therapy will not improve lung function. The am is reduce exacerbation rates and slow the decline in health status.
You should consider the small increased risk of pneuomonia.
Why might a patient with COPD be prescribed an opioid? As couldn’t this cause respiratory depression….
Opioids should be used when appropriate to pallitate breathlessness in patients with end-stage COPD which is unresponsive to other medical therapy.
In patients with COPD who continue to smoke, why is it important to encourage them to stop?
Stopping smoking is one of the few interventions that reduce disease progression in COPD and improve morbidity and mortality.
There is evidence that some therapies such as inhaled steroids may not be as effective in patients who smoke.
Smokers with COPD are more likely to have airway bacteria which may enhance disease progession.
Smoking and COPD are both risk factors for lung cancer.
What is terbutaline?
Short acting beta2 agonist
What is ipratropium
Short acting muscarinic antagonist (Atrovent)
What is Spiriva?
Tiotropium - Long acting muscarinic antagonist
What is seretide?
Long acting beta agonist and ICS combination inhaler
Fluticasone, and salmeteral
What is symbicort?
LABA/ICS combi inhaler
Budenoside plus formeterol
what is polycythemia? why might patients with COPD experience this?
Increase in RBCs caused by chronic exposure to low oxygen levels - body attempts to intake more oxygen by increasing RBC production
