COPD Flashcards
What is COPD?
Processes:
> Chronic bronchitis (persisten expectoration and chronic cough in winter)
> Emphysema (alveolar destruction/ distortion)
> Generalised narrowing
Largely unresponsive to therapy
What are the major differences of asthma and COPD?
COPD vs Asthma
Mid life vs early life
Slow progression vs daily and diurnal variation
Smoking Hx vs associated allergic disease
Irreversible vs reversible
(PLUS asthma has FHx)
What are the main symptoms of COPD?
SOB
Cough (productive)
How can spirometry diagnose COPD?
> Greater reduction in FEV1 therefore FEV1/ FVC < 75%
> Bronchodilators would only cuase minimal improvement
How many people die from COPD?
28,000 annually
3x more than colon cancer
Europe and US 4th leading cause of death
How is smoking affected by low income?
Low income increases risk of smoking, as does being male however, the urge to quit is irrespective of class
What are some emotional pressures of COPD?
Stigma and guilt Financial worries Fatigue and frustration Depression Hoplesness Fear and Downhill path
What is an exacerbation?
Sustained worsening of symptoms from their usual stable state which is beyond normal day to day variations and is acute in onset. Commonly reported symptoms are worsening breathlessness, increased sputum colour and cough. The change in these symptoms often necessitates a change in medication.
What is the treatment of COPD?
> Smoking cessation
Bronchodilators (SABA/ anticholinergic/ LABA/ INH corticosteroid)
Surgery
Pulmonary rehab (Exercise training, nutrition, counselling and education)
Supplementary oxygen
Self management
What are the stages of COPD?
Mild- FEV1/FVC ration < 70% and FEV1 > 80% predicted
Moderate- FEV1/FVC < 70% and FEV1 between 50 and 80% predicted
Severe- FEV1/FVC< 70% and FEV1 between 30% and 50% predicted
Very severe- FEV1/ FVC < 70% and FEV1 < 30% predicted OR <50% predicted with suspected chronic respiratory failure
How do you treat an exacerbation?
Give bronchodilaters
Oral Abx if Hx of purulent sputum
30 mg prednisolone 7-14 days
Oxygen therapy (mask/ intubation/ nasal cannula)
IV theophylline if poor response to bronchodilators
Arrange investigations- ABG, CXR, ECG, FBC/ U&Es/ theophylline blood
When do you use inhaled corticosteroids?
If FEV1<50% predicted with more than 2 exacerbations and requiring Abx and steroid tablets in 12 months
At what level of PaO2 does heart disease, renal hypoxia and dependent oedema become more common?
8kPa
Who gets long term oxygen therapy?
Patient’s who have:
> PaO2 <7.3 and 8.0 when stable
PLUS one of: > Secondary polycythaemia > Nocturnal Hypoxaemia > Peripheral Oedema > Pulmonary HTN
