COPD Flashcards
a ‘common, preventable and treatable disease characterised by non-fully reversible persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the
airways and the lung to noxious particles or gases.
Chronic obstructive pulmonary disease (COPD)
COPD
It is the_______leading cause of death and the
______leading burden of disease in Australia, affecting
12.4% of Australians between 45 and 70 years.
fourth
third
________ is undoubtedly the major cause
of both chronic bronchitis and emphysema, although
only 10–15% of smokers develop the diseases
Cigarette smoking
Occupation at risk for COPD
Occupation: related to cadmium, silica, dusts
Other factors asstd with COPD
- Familial factors: genetic predisposition
- Alpha 1 -antitrypsin deficiency (emphysema)
- Bronchial hyper-responsiveness
Reco for MX of COPD
Confirm diagnosis, Optimise
function, Prevent deterioration, Develop a selfmanagement
plan and manage eXacerbations
Main Sx of COPD
- Breathlessness
- Cough
- Sputum production
Sx with advanced disease
- Fatigue
- Anorexia
- Weight loss
T or F
The sensitivity of the physical examination for
detecting mild to moderate COPD is poor.
T
COPD signs
• __________—always breathless
_________—oedematous and central cyanosis
‘pink puffer’
• ‘blue bloater’
It is
unwise to make a diagnosis of chronic bronchitis
and emphysema in the absence of cigarette smoking
unless there is a family history suggestive of ______
alpha 1 -
antitrypsin deficiency
________ remains the gold standard for diagnosing,
assessing and monitoring COPD. The PEFR is not a
sensitive measure.
Spirometry
Definition of COPD based on PFT
Post-bronchodilator FEV 1 /FVC of <0.70 (<70%)
and FEV 1 <80% predicted
The Australian stages of severity of COPD is based on FEV 1 % predicted
mild
moderate
severe
are mild (60–80%) moderate (40–50%) and severe (<40%),
GOLD staging of severity of COPD is based on FEV 1 % predicted:
- mild ( ≥ 80%),
- moderate (50–80%),
- severe (30–50%),
- very severe (<30%)
ABG of advanced COPD
• PaCO 2 ↑; PaO 2 ↓ (advanced disease)
ECG of COPD
• This may show evidence of cor pulmonale
The only treatment proven to slow the progression of COPD is________
smoking cessation.
In the long-term treatment of COPD, _________
are recommended for the relief of wheezing and
shortness of breath
bronchodilators
Examples of short acting bronchodilators
These include short-acting β 2 -
agonists (SA β As e.g. salbutamol, terbutaline) and
short-acting anticholinergic drugs (ipratropium
bromide);
Examples of LABA
long-acting β 2 -agonists (LA β As e.g.
eformoterol, salmeterol); long-acting anticholinergic
drugs with muscarinic antagonist action (LAMAs e.g.
tiotropium, glycopyrronium)
The evidence suggests that an _______ and _______ are as effective as a nebuliser, but the appropriate method depends on patient needs and preference
MDI and space
____________ can be used in patients
who remain symptomatic despite treatment with
combinations of short-acting bronchodilators and
those with frequent exacerbations.
Long-acting β 2 -agonists
___________ has been proven to
reduce the frequency of exacerbations with COPD
compared with short-acting anticholinergic drugs
Long-acting anticholinergic therapy with tiotropium
bromide (taken by inhalation)
Only 10% of patients with stable COPD benefit in the
short term from _______
inhaled corticosteroids (ICS)
When to give ICS in COPD
1
2
3
•documented evidence of responsiveness to inhaled
corticosteroids, including functional status
• those with an FEV 1 ≤50% predicted
• two or more exacerbations requiring oral steroids
in 12 months
T or F,
OCS can be used as maintenance for COPD
False
Oral corticosteroids are not recommended for
maintenance therapy in COPD, although they may
be needed in patients with severe COPD where
corticosteroids cannot be withdrawn following
an acute exacerbation.
____________ reduces the risk of
exacerbations, hospitalisation and death. It should be
given in early autumn to all patients, especially those
with moderate to severe COPD
Influenza vaccination
In COPD pts, Vaccination to prevent invasive ___________ is recommended. It should
be given at 5-yearly intervals
bacteraemic
pneumococcal pneumonia
_________ reduces mortality
in COPD.
Long-term oxygen therapy (LTOT)
Long-term continuous therapy given for at
least ______ a day (as close as possible to 24 hours a
day) prolongs life in hypoxaemic patients—those who
have PaO 2 consistently <55 mm Hg (7.3 KPa; SpO 2
88%) when breathing air
15 hours
Flow rate for O2 LTOT
A flow rate of 0.5–2.0 L/min is usually sufficient
T or F
No medication has yet been shown to prevent
the long-term decline in lung function
T
___________may reduce the frequency and
duration of exacerbations (evidence level I
Mucolytic agents
Mucolytic therapy should be considered for patients
with a _______
chronic cough productive of sputum.
Regular use of _______ in stable COPD is
contraindicated
antitussives
What are the lung surgery options?
The options are bullectomy, lung volume reduction
surgery and transplantation
Patients should be referred for consideration for __________ if they have a single large bulla on CT scan associated with breathlessness and an FEV 1 <50% predicted
bullectomy
Note that patients with severe COPD are
prone to _________ if they breathe high oxygen
concentrations
hypercapnia
The duration of oral corticosteroid therapy for
exacerbations of COPD is not well established;
however, courses of _______ days are commonly used
7 to 14
The indication for antibiotic treatment in COPD is:
1
2
- increased cough and dyspnoea together with
* increased sputum volume and/or purulence
Abx for bacterial infection in COPD
amoxycillin 500 mg (o), 8 hourly for 5 days
or
doxycycline 200 mg (o) as 1 dose on day 1, then
100 mg (o) daily for a further 5 days
or
azithromycin 500 mg (o) daily for 5 days
Mx of COPD Stage 0
Avoidance of risk factors, esp. smoking
Influenza and pneumococcal
vaccination ? Haemophilus influenza
vaccination
Mx of COPD Stage 1
Avoidance of risk factors, esp. smoking
Influenza and pneumococcal
vaccination ? Haemophilus influenza
vaccination
Add short-acting bronchodilator
Mx of COPD Stage 2 Moderate
Avoidance of risk factors, esp. smoking
Influenza and pneumococcal
vaccination ? Haemophilus influenza
vaccination
Add short-acting bronchodilator
Add long-acting bronchodilators
LAMA + LAβA
Consider LAβA/ICS and referral
Add pulmonary rehabilitation
Mx of COPD Stage 3 Severe
Moderate + Add inhaled corticosteroids
LAβA/ICS + LAMA
Mx of COPD Stage 4 Very severe
Add long-term oxygen (if chronic
respiratory failure)
Consider theophylline (o) or roflumilast
Consider surgical referral
