COPD Flashcards
What is COPD?
Airflow obstruction that is not fully reversible.
Can COPD be reversed?
No there is only modest reversibility following a bronchodilator
What are the symptoms of COPD?
Wheeze, exertional breathlessness, chronic cough, regular sputum production, frequent winter bronchitis.
Why is airflow obstructed in COPD?
Due to airway and parenchymal damage caused by chronic inflammation that differs from that seen in asthma.
Give 3 risk factors for COPD
Smoking, male gender, alpha 1 antitrypsin deficiency
List the stages of COPD and their corresponding FEV1
Stage 1- mild, FEV1 >80%
Stage 2- moderate, FEV1 50-79%
Stage 3- severe, FEV1 30-49%
Sage 4- very severe, FEV1 <30%
What is used to asses prognosis of COPD?
The BODE index
What does the BODE index stand for?
BMI, obstruction, dyspnoea and exercise capacity
What is the mechanism of action of antmuscarinics?
Block bronchoconstrictor effects of acetylcholine on M3 muscarinic receptors. Reduce vagal airway tone and reflex bronchoconstriction
Give an example of a SAMA
Ipratropium
Give an example of a LAMA
Tiotropium
What are the side effects of antimuscarinics?
Dry mouth, blurred vision, constipation, urinary retention and hypotension
Why is smoking a caution in the use of methylxanthines?
Because they interact with cigarette smoke
Why are bone protective agents such as calcium and vitamin D prescribed in patients on long term oral steroids?
Because a side effect of oral steroids is osteoporosis
What is the mechanism of action of mucolytics such as carbocisteine and mecysteine?
They facilitate expectoration by reducing sputum viscosity
Which antibiotic is used prophylactically in COPD patients?
Azithromycin 250mg TDS
Which patients is long term oxygen therapy indicated for?
If the patient has an FEV1 of less than 30% and is symptomatic or if the patient has polycythaemia or cor pulmonale or if the patients oxygen sats are less than 92% or the patient is chronically breathless to the point it affects daily life.
Name the main hazard for long term oxygen therapy
Smoking!
How long is long term oxygen therapy?
More than 15 hours a day
What concentration of oxygen should be used in COPD patients and how is this different to asthma patients?
Use 24-28% oxygen, this is much lower than asthma (40-60%) in order to prevent a reduction in respiratory drive
What is the target oxygen sats for COPD patients?
88-92%
What is hypercapnia?
When COPD patients have a change in respiratory drive so take breath in response to low oxygen levels instead of high CO2 levels
What is cor pulmonale?
Right sided heart failure due to COPD
What is polycythaemia?
Increased viscosity of blood due to increased number of red blood cells in response to hypoxia
Why must a patient with COPD’s BMI be maintained between 20 and 25?
Because low BMIs are associated with higher mortality
What is a rescue pack?
A course of antibiotics and corticosteroids to keep at home for patients at risk of an exacerbation of COPD
