COPD Flashcards
What is the mnemonic for taking a breathless history ?
ONERESP + timing constant or intermittent
Onset
Nature: what it’s like
Extent of it: how far can you walk before
Relieving: resting, inhalers
Exacerbating (lying flat),
Sleep: does it disturb your sleep ?
P: pillows: do you have to prop yourself up with pillows?
What is COPD ?
A chronic disease of the lungs and it’s usually progressive. It’s a combination of two conditions.
Chronic bronchitis: chronic inflammation of the small airways of the lungs leading to chronic cough with sputum and emphysema: damage to the tiny air spaces in the lungs, decreasing the amount of air getting into the lungs, making you breathless
symptoms of COPD
Chronic cough with sputum production (clear/white fluid) worse in the morning; wheeze (a whistle in chest as the you breathe out) and breathless, particularly on exertion.
What is the structure for COPD ?
DMS
What is it ? Symptoms, causes/RF/triggers, management: treatment (side effects) and monitoring; safety netting
What are the risk factors ? (4)
- Smoking (biggest risk factor);
- Occupation: mining, those involving specific chemicals, 3. Air pollution: due to climate change 4. Genetic: alpha 1 antitrypsin deficiency
Safety netting
Acute exacerbation of COPD brought on by a chest infection. When your symptoms getting worse or you this has occurred come into the GP
What does the main management of COPD involve ? (4)
- Lifestyle changes: smoking cessation service(new leaf), lose weight if overweight (help with breathlessness) and exercise; 2. Physiotherapy: To help clear phlegm, 3. Immunisations: Annual flu vaccine is vital as is the one-off pneumococcal vaccine 4. Medications and monitoring of lung function
What does the medications of COPD involve ?
SABA(salbutamol) or SAMA(ipratropium bromide) for when you get breathless;
If FEV1 > 50%: LABA: salmeterol or LAMA (must stop SAMA): if symptoms persist: combination inhaler of LAMA +LABA + corticosteroid
If FEV1 < 50%: Combination inhaler: LABA + ICS or LAMA; if symptoms persist: combination inhaler of LAMA + LABA + corticosteroid
If there is evidence of poor response to the medications above, what is given ?
Oral theophylline
What does additional therapy involve ? (2)
Mucolytic therapy: if chronic productive cough and home oxygen therapy if hypoxic and home nebulisers
If patient struggling to use inhaler, what would you give them ?
Check the inhaler technique: if wrong; show them the technique; if correct; give them a spacer
If patient with COPD has recurrent chest infections what would you do ?
Check inhaler technique
And compliance and date of the medication is correct
Treatment for acute exacerbation
Oral prednisolone for 7-14 days
INH/NEB Bronchondilators or consider IV theophylline if severe
O2 in hospital done carefully so patient doesnt retain CO2
What would you give if persistent hypercapnia:
non-invasive ventilation: BiPAP; or if it still persists: invasive ventilation: intubation in ICU
When will you follow them up ?
2 weeks
