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CR3 > COPD > Flashcards

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
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2
Q

Define exacerbations

A

Rapid sustained worsening of symptoms beyond normal day to day variations

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3
Q

Define chronic bronchitis

A

presence of chronic productive cough and sputum for at least 3 months in each of 2 successive years

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4
Q

Define emphysema

A

Enlarged alveolar spaces and loss of alveolar walls

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5
Q

How to calculate pack years

A

= number of packs per day x years smoked

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6
Q

How many cigarettes in a pack?

A

20

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7
Q

Causes of COPD

A
  • tobacco smoke
  • indoor air pollution (smoke, biomass fuels)
  • occupational dusts, chemical agents and fumes
  • outdoor air pollution
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8
Q

Pathophys of chronic bronchitis

A
  • hypertrophy of mucus secreting glands
  • increased mucus production
  • infiltration of bronchial walls with inflammatory cells = airways narrow
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9
Q

Pathophys of emphysema

A
  • loss of elastic recoil = airflow limitation and air trapping
  • bulla formation
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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
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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
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12
Q

Diagnostic factor main for COPD

A

FEV1<80

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13
Q

Stages of COPD

A 
1 = FEV1>80
2 = 50-79
3 = 30-49
4 = <30
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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
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15
Q

What do normal spirometry values vary with?

A
  • age
  • height
  • race
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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
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17
Q

COPD symptoms presentation how

A
  • age
  • COPD symptoms slowly progressive
  • smoking history long
  • dyspnea during exercise
  • irreversible airflow limitation
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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
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19
Q

Peak flow with COPD

A
  • reduced
  • little day to day variation
  • asthma diurnal variation and day to day
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20
Q

Bronchodilator response

A
  • symptomatic response

- asthma symptomatic and lung function response

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21
Q

Corticosteroid response

A
  • small response to lung function

- better with asthma

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22
Q

COPD signs

A
  • wheeze
  • tachypnoea
  • prolonged expiration
  • accessory muscle use
  • pursed lip breathing
  • hyper inflated lungs
  • cyanosis
  • HF
  • Dahl’s sign
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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
Q

Smoking cessation drugs

A
  • varenicline (Champix)
  • nicotine replacement therapy
  • bupropion (Zyban)
  • E-cigarettes (not safe LT)
26
Q

MOA of varenicline

A
  • selective nicotine receptor partial agonist
27
Q

Forms of nicotine replacement

A
  • use in abrupt cessation or to slowly reduce
  • patches
  • gum/lozenges/ oro-nasal spray
  • inhalator
28
Q

Vaccines

A
  • influenza vaccine
  • reduce serious illness
  • pneumococcal polysaccharide for >65 years or if <65 and FEV1 <40% predicted
29
Q

Drugs used

A
  • short acting bronchodilators with anticholinergics
  • LABA with anticholinergics
  • inhaled corticosteroids
  • phosphodiesterase inhibitors
30
Q

Examples of short acting bronchodilators

A

Salbutamol

Terbutaline

31
Q

Anticholinergics to use with short acting bronchodilators

A

Ipratropium bromide

32
Q

LABA e.g

A

Formoterol
Salmeterol
Vilanterol
Indacterol

33
Q

Anticholinergics to use with LABAs

A

Aclidinium
Glycoppyroium
Tiotropium

34
Q

Phosphodiesterase Inhibitor e.g.

A

Theophyllines

Roflumilast

35
Q

What treatment to use for group A?

A
  • bronchodilator
36
Q

What treatment to use for Group B?

A

LABA or LAMA

37
Q

What treatment to use for group C?

A

LAMA

38
Q

What treatment to use for Group D?

A
  • LAMA or LAMA + LABA or ICS + LABA
39
Q

Non pharm treatments

A
  • REHAB
  • oxygen therapy (>15 hours per day long term with chronic resp failure)
  • lung volume reduction surgery
  • lung transplant
40
Q

Complications

A

Resp Failure

Cor Pulmonale

41
Q

Define Resp Failure

A

PaO2<7 and/or PaCO2 6.5

42
Q

Define cor pulmonale

A

Heart disease 2ndry to chronic lung disease

43
Q

When to ABG

A

FEV1<30%
Cor Pulmonale
O2 sats <92% on air

44
Q

How to treat Resp Failure

A

Long term oxygen therapy

NIV

45
Q

When is LTOT life prolonging?

A
  • use >15 hrs/day

- PaO2 <7.3 or <8 with polycythaemia, nocturnal hypoxaemia, peripheral oedema, pulmonary hypertension

46
Q

Define nocturnal hypoxaemia

A

<90% for >30% of night

47
Q

What should pulmonary rehab include?

A

Physical training
Disease education
Nutritional advice
Psychological and behavioural support

48
Q

Palliative Treatments

A 
Fans for dyspnoea
Anxiety/Insomnia = CBT
Nutrition support
Pulmonary rehab
Opiates for breathlessness
SSRI for depression and anxiety
49
Q

Define exacerbation

A
  • 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
Q

Differentials of exacerbation

A 
Pneumonia
Pneumothorax
Malignancy
PE
HF/ACS
51
Q

Investigations for exacerbation

A
  • ox sats
  • ABG
  • sputum and blood cultures
  • CXR
  • ECG
  • Bloods (eosinophil count, U&E, CRP, theophylline, cardiac enzymes)
  • CT
52
Q

Infective organisms in exacerbations

A
  • often viral
  • pneumonia
  • H influenzae
  • M. catarrhalis
    Strep pneumoniae
53
Q

Management of exacerbations

A
  • bronchodilators (nebulised or air)
  • steroids
  • AB
  • hospital at home team?
54
Q

Which steroids to give in exacerbation?

A
  • prednisolone
  • 30-40mg
  • OD
  • max 5 days
55
Q

Procedure for AB treatment in exacerbation

A
  • if purulent sputum or pneumonia on CXR
  • Empircal Rx with aminopenicllin or tetracycline
  • change if cultures/sensitivies known
56
Q

Oxygen in exacerbation

A
  • aim for 88-92%
  • ABG to exclude hypercapnia
  • exclude acidosis
  • NIV if no improvement of resp acidosis

CR3 (30 decks)

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