COPD Flashcards
A progressive disorder characterized by airway obstruction with 2 main things:
emphysema and chronic bronchitis
in COPD - what is their:
FEV1?
FEV1/FVC ratio?
o FEV1 <80%
o FEV1:FVC ratio is <70%
Emphysema?
enlarged distension of the air sacs with alveolar wall damage.
alveoli elastic recoil is absent
COPD patients have a hyperinflated chest:
- what determines a hyperinflated chest?
• Hyperinflated chest = >6 anterior ribs above the diaphragm and increased radiolucency of the lungs
what is chronic bronchitis?
Defined clinically as cough with sputum for at least 3 months in 2 successive years.
2 types of COPD patients:
pink puffers and blue bloaters
- which one is overweight and cyanosed?
- which one is just (dyspnoea + cough) and which also has sputum?
- which one is hypercapnic?
- what type Resp failure is each one?
which one is predominantly emphysema and which is chronic bronchitis?
Pink puffers = thin and not cyanosed
Blue bloaters = overweight and cyanosed
- pink puffer = dyspnoea + cough
- blue bloater = dyspnoea + cough + sputum
Pink puffer = Type 1 resp failure
Blue bloater = Type 2 resp failure
Pink puffer = emphysema
Blue bloater = chronic bronchitis
smoking accounts for ?
90% of patients (rarely alpha 1 antitrypsin deficiency)
Mx for Chronic Stable COPD
Step 1 = start all patients on?
Step 2
a ) if FEV1 >50 = add what?
b) if FEV1 <50 = add what?
STEP 3
If still uncontrolled - a) patients can add? , b) patients can add?
Step 4
If a) patients still uncontrolled - add?
Step 1
Give SABA (salbutamol) or SAMA (ipratropium) inhaler
Step 2
a ) if FEV1 >50 = LABA (salmeterol)
b) if FEV1 <50 = LABA + ICS
or both sets can add LAMA instead and jump to Step 4 instead - LAMA + LABA + ICS
Step 3
a) LABA + ICS
b) LAMA (tiotropium) + LABA + ICS
Step 4
a) LAMA + LABA + ICS
who should get long term oxygen therapy?
- Clinically stable non-smokers with PaO2 <7.3kPa.
- If PaO2 between 7.3-8 kPa + pulmonary HT, polycythaemia, peripheral oedema or nocturnal hypoxia.
- Terminally ill patients.
Acute Exacerbation of COPD
May be triggered by viral/bacterial infections. Present with increasing SOB, cough and wheeze.
ACRONYM
Need Oxygen Stay Alive And Ventilate
Nebulised salbutamol + ipratropium Oxygen therapy Steroids (IV hydrocortisone + oral prednisolone) Abx Aminophylline IV NIV - BiPAP not CPAP
what can severe COPD lead to as a result of pulmonary hypertension resulting in RV failure?
Cor pulmonale
Signs of cor pulmonale?
tricuspid regurgitation
raised JVP
cyanosis
peripheral oedema
COPD patients can have a influenza vaccine and pneumococcal vaccine:
which one is annual and which one is one-off?
annual influenza vaccination
one-off pneumococcal vaccination
A 62-year-old woman with recently diagnosed chronic obstructive pulmonary disease (COPD) presents for review. Her FEV1 is 65% of the predicted value. She has managed to give up smoking and was prescribed a salbutamol inhaler to use as required. Despite this she is still symptomatic and complains of wheeze and shortness of breath. What is the most appropriate next step?
add ICS
add LAMA
add oral theophylline
add LABA + ICS
add LAMA
FEV1 needs to be <50 to get LABA + ICS
A 62-year-old female is admitted with a suspected infective exacerbation of COPD. A chest x-ray shows no evidence of consolidation. What is the most likely causative organism?
Haem influenza
Staph aureus
Strep pneumonia
Haem influenza
If the patient had pneumonia then Streptococcus pneumoniae would be the most likely causative organism. However, the chest x-ray shows no evidence of consolidation making a diagnosis of pneumonia unlikely.
Haemophilus influenzae is the most common cause of infective exacerbations of COPD
most common cause of infective exacerbations of COPD?
Haemophilus influenzae
A 54-year-old woman with chronic obstructive pulmonary disease (COPD) is prescribed an inhaled corticosteroid. What is the main therapeutic benefit of inhaled corticosteroids in patients with COPD?
reduced severity of exacerbations
slows decline of FEV1
reduced frequency of exacerbations
reduced frequency of exacerbations
COPD - reason for using inhaled corticosteroids - reduced exacerbations
What is the main criteria for determining whether a patient with chronic obstructive pulmonary disease (COPD) should be offered long-term oxygen therapy?
COPD - LTOT if 2 measurements of pO2 < 7.3 kPa
You are doing the annual review of a 72-year-old man with chronic obstructive pulmonary disease (COPD). Last year he had three exacerbations of his COPD, one of which resulted in him being hospitalised. Today his chest is clear and his oxygen saturations are 94% on room air. According to NICE guidelines, what treatment should you offer him?
home supply of oxygen home nebuliser home supply of Abx home supply of prednisolone home supply of prednisolone + Abx
home supply of prednisolone + Abx
In the 2010 NICE guidelines there is a recommendation that patients who have frequency exacerbations of COPD should be given a home supply of corticosteroids and antbiotics.
You review a 60-year-old woman in the COPD clinic. She was diagnosed with COPD four years ago and is currently maintained on a salbutamol inhaler as required and a tiotropium inhaler regularly. She has recently managed to give up smoking and her latest FEV1 was 42% of predicted. Despite her current therapy she is have frequent exacerbations. What is the most appropriate next step in her management?
salmeterol inhaler salmeterol + fluticasone inhaler long term oxygen therapy betamethasome inhaler oral aminophylline
salmeterol + fluticasone inhaler
Which one of the following interventions is most likely to increase survival in patients with COPD?
home nebuliser tiotropium inhaler long term steroid therapy smoking cessation long term oxygen therapy
smoking cessation
You are reviewing the management of a number of patients with chronic obstructive pulmonary disease (COPD). Which one of the following factors should prompt an assessment for long-term oxygen therapy?
FEV1 54%
Hb 18.4 (high)
BMI 18
sats 93%
Hb 18.4 (high)
polycythaemia
Nancy, 72, is diagnosed with chronic obstructive pulmonary disease (COPD). Despite using a short-acting beta agonist along with a short-acting muscarinic antagonist, she is still breathless at rest. Her current FEV1 is found to be 45%. Which of the following would be the most appropriate next step in her management?
LABA ICS ICS + LAMA ICS + LABA LABA + LAMA
ICS + LABA
You are reviewing a patient with chronic obstructive pulmonary disease (COPD) who remains breathless despite using an ipratropium bromide inhaler as required. Her FEV1 is 40%. What are the two main options?
LABA or ICS
LAMA or LABA +ICS
LABA or LAMA
LAMA + ICS or LABA
LAMA or LABA +ICS
