COPD Flashcards
What does alpha-1 anti-trypsin deficiency predispose to?
Emphysema
COPD patients often have regular sputum production, what colour is this normally?
Whitish
Why is an FBC a useful investigation in COPD?
The patient may have raised RCC and MCV due to secondary polycythaemia as a result of chronic hypoxia
A diagnosis of COPD should be considered in anyone who has Sx of COPD, a risk factor for COPD and is above what age?
35
How is COPD diagnosed?
Clinical history, examination and demonstration of airflow obstruction using spirometry (no improvement following bronchodilator)
How is chronic bronchitis diagnosed?
Clinical diagnosis - productive cough on most days for 3 months of 2 consecutive years
How is emphysema diagnosed?
Histiological diagnosis but this is often too invasive so usually diagnosed clinically.
What FEV1/FVC ratio is expected in COPD?
< 0.7
How is COPD classified by severity using spirometry?
Stage 1 (mild): FEV1 >= 80% of predicted but presence of Sx Stage 2 (moderate): FEV1 50-79% of predicted value Stage 3 (severe): FEV1 30-49% of predicted value Stage 4 (very severe): FEV1 <30% of predicted value
What scale is used to classify COPD subjectively?
MRC dyspnoea scale Grade 1: SOB with strenuous exercise Grade 2: SOB going uphill Grade 3: Have to stop for breath when walking Grade 4: Stops for breath after 100m Grade 5: SOB when dressing/undressing
Pulmonary rehab should be offered to those grade 3 and above
What is the first inhaled therapy that should be offered to COPD patients once conservative measures have been tried and Sx persist?
Short acting B2 agonist (e.g. salbutamol)
OR
Short acting muscarinic antagonist (e.g. ipratropium bromide)
If adequate control not achieved following the first inhaled therapy, what should then be offered if FEV1 < 50% or steroid-responsive features are present?
Add Long acting B2 agonist and Inhaled corticosteroid in combi-inhaler (e.g. seratide)
OR
Long acting muscarinic antagonist (e.g. tiotropium) but must discontinue SAMA if using.
If adequate control not achieved following the first inhaled therapy, what should then be offered if FEV1 >= 50% or steroid-responsive features are not present?
Long acting B2 agonist (e.g Salmeterol)
OR
Long acting muscarinic antagonist (e.g. tiotropium) but must discontinue SAMA if using.
What triple therapy should be offered if there is still inadequate control after initial intensification of inhaled therapies?
LABA+ICS in combi-inhaler (e.g. Seratide) PLUS LAMA (e.g. tiotropium)
What are some indications for long term oxygen therapy?
SpO2 < 92% for >30% of the time, FEV1 < 30%, cyanosis, polycythamia, peripheral oedema, raised JVP, 2 ABGs measured at least 3 weeks apart showing PaO2 < 7.3
