COPD Flashcards
Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe which progressive lung diseases? (3)
1) Emphysema
2) Chronic bronchitis
3) Refractory (non-reversible) asthma
what is the main risk factor for the development of COPD?
Smoking - Smoking cessation reduces the progressive decline in lung function
Infection can complicate COPD, how can this be prevented?
vaccination:
1) pneumococcal vaccine
2) influenza vaccine (free)
what should be trialed in patients with moderate or severe airflow obstruction if the diagnosis is in doubt?
high-dose ICS or an oral corticosteroid
Symptoms of COPD may be alleviated by an inhaled SABA or a SAMA used as required. when should regular inhaled therapy be used?
When the airways obstruction is more severe. (important to check compliance and inhaler technique before initiating a new drug)
1) If FEV1 is ≥ 50% of predicted what drugs should be started in COPD and what drugs be discontinued?
2) what is the next step if the patient experiences persistent exacerbations or breathlessness?
1)► exacerbations/breathlessness: Either a LABA or LAMA
↳ SAMA should be discontinued when a LAMA is started
b) A LABA + ICS in a combination inhaler can be used for patients who remain symptomatic despite regular treatment with a LABA
3) ►persistent exacerbations/breathlessness: Triple therapy with LABA + ICS in a combination inhaler + a LAMA should be used.
1) If FEV1 is ≤ 50% of predicted, what drugs should be prescribed in COPD and what drugs should be discontinued?
2) what if the patient continues to remain symptomatic?
1) ► exacerbations/breathlessness: Either a LAMA OR LABA + ICS in a combination inhaler should be used.
↳ Discontinue SAMA if LAMA started
2)► Persistent exacerbations/breathlessness: Triple therapy with LABA + ICS in a combination inhaler + a LAMA should be used.
If FEV1 is ≤ 50% of predicted and an ICS is inappropriate, what combination of drugs can be used in exacerbations or persistent breathlessness of COPD?
LABA with an LAMA
when would oral M/R aminophylline or theophylline be used in COPD?
if a person with stable COPD is still symptomatic after a trial of short-acting and long-acting bronchodilators (with or without inhaled corticosteroids), or cannot use inhaler devices successfully
what class of drug is Indacaterol, and what is it licensed to treat?
LABA - licensed for the maintenance treatment of COPD
1) name TWO mucolytics used in COPD
2) when would a mucolytic be considered in COPD?
1) Carbocisteine and acetylcysteine- licensed for COPD
2) in a patient with a chronic productive cough
what is the benefit of using long term oxygen therapy in COPD?
prolongs survival in patients with severe COPD and hypoxaemia
How should a person with an acute exacerbation of COPD be treated? (3)
1) Bronchodilator can be administered through a nebuliser if necessary and oxygen given if appropriate
↳Aminophylline IV if response to bronchodilators is poor
2) Prescribe prednisolone 30 mg once daily for 7-14 days, if increased breathlessness interferes with daily activities
3) Prescribe oral antibiotics for people with purulent sputum or clinical signs of pneumonia.
↳ Amoxicillin 500 mg TDS for 5 days (alternatives doxy or claritho)
what should be given to patients who have an episode of hypercapnic respiratory failure?
24% or 28% Venturi mask and an oxygen alert card endorsed with the oxygen saturations required during previous exacerbations
what should be considered in COPD patients requiring frequent courses of oral corticosteroids (3–4 courses per year)
Consider osteoporosis prophylaxis
