COPD Flashcards
1
Q
Define COPD
A
- airflow obstruction
- not fully reversible
- progressive in LT
- does not change over several months
- smoking cause
- occupational exposures contribute
2
Q
Define exacerbations
A
Rapid sustained worsening of symptoms beyond normal day to day variations
3
Q
Define chronic bronchitis
A
presence of chronic productive cough and sputum for at least 3 months in each of 2 successive years
4
Q
Define emphysema
A
Enlarged alveolar spaces and loss of alveolar walls
5
Q
How to calculate pack years
A
= number of packs per day x years smoked
6
Q
How many cigarettes in a pack?
A
20
7
Q
Causes of COPD
A
- tobacco smoke
- indoor air pollution (smoke, biomass fuels)
- occupational dusts, chemical agents and fumes
- outdoor air pollution
8
Q
Pathophys of chronic bronchitis
A
- hypertrophy of mucus secreting glands
- increased mucus production
- infiltration of bronchial walls with inflammatory cells = airways narrow
9
Q
Pathophys of emphysema
A
- loss of elastic recoil = airflow limitation and air trapping
- bulla formation
10
Q
`Difference between asthma and COPD Pathophys
A
- asthma mostly reversible
- asthma causes CD4+ lymphocytes activating eosinophils, macrophages, mast cells
- COPD causes CD8+ lymphocytes activating macrophages and neutrophils
11
Q
COPD symptoms
A
- over 35
- smoker/ex
- exertional breathlessness
- chronic cough
- regular sputum production
- frequent winter bronchitis
- wheeze
- morning cough with sputum
- peripheral oedema
12
Q
Diagnostic factor main for COPD
A
FEV1<80
13
Q
Stages of COPD
A
1 = FEV1>80 2 = 50-79 3 = 30-49 4 = <30
14
Q
Management for COPD
A
- treat airflow obstruction
- monitor treatment adherence
- follow over time
- consider pulmonary rehab? (if MMRC > or equal to 2)
- assess gas exchange of MMRC =2 or greater
15
Q
What do normal spirometry values vary with?
A
- age
- height
- race
16
Q
Modified MRC Dyspnea Scale
A
0 = breathless with strenuous exercise 1 = SOB when hurrying on level or walking up slight hill 2 = walk slower than people of same age on level as breathless or have to stop for breath when walking on my own pace on the level 3 = stop for breath walking 100m or after a few mins on level 4 = too breathless to leave house or breathless when dressing/undressing
17
Q
COPD symptoms presentation how
A
- age
- COPD symptoms slowly progressive
- smoking history long
- dyspnea during exercise
- irreversible airflow limitation
18
Q
Asthma symptoms presentation how
A
- child
- symptoms vary day to day
- symptoms at night or early morning
- allergy/rhinitis/eczema
- FH
- largely reversible
19
Q
Peak flow with COPD
A
- reduced
- little day to day variation
- asthma diurnal variation and day to day
20
Q
Bronchodilator response
A
- symptomatic response
- asthma symptomatic and lung function response
21
Q
Corticosteroid response
A
- small response to lung function
- better with asthma
22
Q
COPD signs
A
- wheeze
- tachypnoea
- prolonged expiration
- accessory muscle use
- pursed lip breathing
- hyper inflated lungs
- cyanosis
- HF
- Dahl’s sign
23
Q
Refined ABCD Assessment Tool
A
A = 0-1 exacerbations and mMRC 0-1 B = 0-1 exacerbations and mMRC ≥ 2 C = ≥ 2 exacerbations or ≥ 1 leading to hospital admission and mMRC 0-1 D = ≥ 2 exacerbations or ≥ 1 leading to hospital admission and mMRC ≥2
24
Q
3 stages of smoking cessation
A
ask
advice
act
25
Smoking cessation drugs
- varenicline (Champix)
- nicotine replacement therapy
- bupropion (Zyban)
- E-cigarettes (not safe LT)
26
MOA of varenicline
- selective nicotine receptor partial agonist
27
Forms of nicotine replacement
- use in abrupt cessation or to slowly reduce
- patches
- gum/lozenges/ oro-nasal spray
- inhalator
28
Vaccines
- influenza vaccine
- reduce serious illness
- pneumococcal polysaccharide for >65 years or if <65 and FEV1 <40% predicted
29
Drugs used
- short acting bronchodilators with anticholinergics
- LABA with anticholinergics
- inhaled corticosteroids
- phosphodiesterase inhibitors
30
Examples of short acting bronchodilators
Salbutamol
| Terbutaline
31
Anticholinergics to use with short acting bronchodilators
Ipratropium bromide
32
LABA e.g
Formoterol
Salmeterol
Vilanterol
Indacterol
33
Anticholinergics to use with LABAs
Aclidinium
Glycoppyroium
Tiotropium
34
Phosphodiesterase Inhibitor e.g.
Theophyllines
| Roflumilast
35
What treatment to use for group A?
- bronchodilator
36
What treatment to use for Group B?
LABA or LAMA
37
What treatment to use for group C?
LAMA
38
What treatment to use for Group D?
- LAMA or LAMA + LABA or ICS + LABA
39
Non pharm treatments
- REHAB
- oxygen therapy (>15 hours per day long term with chronic resp failure)
- lung volume reduction surgery
- lung transplant
40
Complications
Resp Failure
| Cor Pulmonale
41
Define Resp Failure
PaO2<7 and/or PaCO2 6.5
42
Define cor pulmonale
Heart disease 2ndry to chronic lung disease
43
When to ABG
FEV1<30%
Cor Pulmonale
O2 sats <92% on air
44
How to treat Resp Failure
Long term oxygen therapy
| NIV
45
When is LTOT life prolonging?
- use >15 hrs/day
| - PaO2 <7.3 or <8 with polycythaemia, nocturnal hypoxaemia, peripheral oedema, pulmonary hypertension
46
Define nocturnal hypoxaemia
<90% for >30% of night
47
What should pulmonary rehab include?
Physical training
Disease education
Nutritional advice
Psychological and behavioural support
48
Palliative Treatments
```
Fans for dyspnoea
Anxiety/Insomnia = CBT
Nutrition support
Pulmonary rehab
Opiates for breathlessness
SSRI for depression and anxiety
```
49
Define exacerbation
- in course of disease
- change in patients baselines
- change in dyspnea, cough, sputum volume and purluence
- beyond normal variation
- acute onset
- may warrant medication change
50
Differentials of exacerbation
```
Pneumonia
Pneumothorax
Malignancy
PE
HF/ACS
```
51
Investigations for exacerbation
- ox sats
- ABG
- sputum and blood cultures
- CXR
- ECG
- Bloods (eosinophil count, U&E, CRP, theophylline, cardiac enzymes)
- CT
52
Infective organisms in exacerbations
- often viral
- pneumonia
- H influenzae
- M. catarrhalis
Strep pneumoniae
53
Management of exacerbations
- bronchodilators (nebulised or air)
- steroids
- AB
- hospital at home team?
54
Which steroids to give in exacerbation?
- prednisolone
- 30-40mg
- OD
- max 5 days
55
Procedure for AB treatment in exacerbation
- if purulent sputum or pneumonia on CXR
- Empircal Rx with aminopenicllin or tetracycline
- change if cultures/sensitivies known
56
Oxygen in exacerbation
- aim for 88-92%
- ABG to exclude hypercapnia
- exclude acidosis
- NIV if no improvement of resp acidosis
