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Patient PCP > COPD > Flashcards

COPD Flashcards

1
Q

What is the biggest cause of COPD?

A

Smoking - offer smoking cessation

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2
Q

When can a diagnosis of COPD be considered in patients over the age of 35? - what risk factors?

A

(generally a smoker) and presenting with 1 or more of the following symptoms:

  • exertional breathlessness
  • chronic cough
  • regular sputum production
  • frequent winter ‘bronchitis’
  • wheeze
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3
Q

What diagnostic tests are carried out?

A
  • Spirometry
  • Chest Radiograph (CXR)
  • FBC to identify anaemia or polycythaemia
  • BMI
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4
Q

What else should be looked out for when thinking about a COPD diagnosis?

A
  • weight loss
  • reduced exercise tolerance
  • waking at night with breathlessness
  • ankle swelling
  • fatigue
  • occupational hazards
  • chest pain
  • haemoptysis (coughing up blood)

*last 2 symptoms are uncommon in COPD - raise possibility of alternative diagnosis

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5
Q

What is given as initial empirical treatment in COPD to relieve symptoms of breathlessness and exercise limitation?

A

Short acting beta2 agonist (SABA) or Short acting muscarinic antagonists (SAMA)

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6
Q

What is recommended in patients with moderate or severe airflow obstruction if diagnosis is in doubt?

A
  • Trial of high dose ICS or oral corticosteroid
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7
Q

What should be checked before initiating new therapy?

A

inhaler compliance and technique

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8
Q

What are the side effects of ICS that patients should be aware of?

A
  • oral thrush

- non-fatal pneumonia

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9
Q

Why is it important to measure the post-bronchodilator spirometry?

A
  • To check for possible asthma diagnosis, shown with reversibility - this differentiates from COPD
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10
Q

What are the aims of treatment in COPD?

A
  1. Reduce breathlessness

2. Reduce exacerbation frequency

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11
Q

People with stable COPD who remain breathless or have exacerbations despite using SABA as required can be offered what?

A

OD LAMA in preference to QDS SAMA

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12
Q

What is the maintenance therapy in patients with stable COPD who remain breathless etc with FEV1 > 50% predicted?

A
  • If FEV > 50% predicted: LABA or LAMA
  • SAMA discontinued when LAMA started
  • FEC < 50%: either LABA+ICS or LAMA
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13
Q

In a pt with stable COPD but still breathlessness, when would LABA+ICS be recommended as maintenance therapy?

A
  • when FEV1 < 50% predicted

- could also use LAMA instead

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14
Q

In patients with stable COPD and an FEV1 > 50% who remain breathless or have exacerbations despite maintenance therapy with LABA, what can be considered as further treatment?

A
  • LABA+ICS combination inhaler

- LAMA in addition to LABA when ICS not tolerated/contraindicated

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15
Q

LAMA should be added to LABA+ICS therapy if pt remains breathless/exacerbations irrespective of what?

A

Irrespective of FEV1

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16
Q

When would maintenance dose of oral corticosteroid be used?

A

In advanced COPD

17
Q

What must be considered in those on long term oral corticosteroid treatment?

A
  • monitor for development of osteoporosis.

- those >65yrs should be started on prophylactic treatment without monitoring

18
Q

When should mucolytic therapy be used?

A

In patients with a chronic cough productive of sputum

19
Q

LABA and LAMA are recommended in what patients?

A
  1. Pts who remain breathless or have exacerbations despite:
  2. using SABAs as needed and have
  3. FEV1 less than 50% predicted and
  4. have declined/ cannot tolerate ICS
20
Q

What is triple therapy?

A

SABA prn + LABA/ICS combo + LAMA

*offered if patient remains breathless or has continuous exacerbations (e.g. 2 in a year)

21
Q

What 5 things should be considered in the management of an acute exacerbation of COPD

A
  1. Antibiotics (duration of and 5 days post, oral where possible)
  2. Steroids (prednisolone 30mg 7-14 days + CONTINUE patients ICS if they have it) - based on severity, response and previous treatment
  3. Bronchodilators nebulised driven by AIR (not oxygen) [STOP any tiotropium]. Salbutamol 2.5mg 4 hourly + ipratropium QDS [max] 500micrograms
  4. VTE risk assessment
  5. Oxygen sats target lower than asthma at 88-92%
22
Q

What is the target O2 saturation in COPD exacerbation?

A

88-92%

23
Q

What are the antibiotics (GMMMG) used in acute exacerbation of COPD?

A
  • First line: Doxycycline po 200mg stat followed by 100mg OD for 5 days
  • amoxicillin and clarithromycin also used
  • second line: co-amoxiclav po 625mg TDS for 5 days
  • maintenance antibiotics: first line azithromycin 250mg three times a week (prophylactic) in non-smokers *more risk criteria
24
Q

What is licenced as an adjunct to existing bronchodilator therapy in patients with severe COPD associated with chronic bronchitis and a history of frequent exacerbations?

A
  • rofluminast
25
Q

What treatment prolongs survival in patients with severe COPD and hypoxaemia?

A
  • long term oxygen therapy
26
Q

When should oral prophylactic antibiotic therapy be considered?

A

Consider azithromycin (usually 250 mg 3 times a week) for people with COPD if
they:
• do not smoke and
• have optimised non-pharmacological management and inhaled therapies, relevant
vaccinations and (if appropriate) have been referred for pulmonary rehabilitation and
• continue to have 1 or more of the following, particularly if they have significant daily
sputum production:
－ frequent (typically 4 or more per year) exacerbations with sputum production
－ prolonged exacerbations with sputum production
－ exacerbations resulting in hospitalisation.[4]
[2018]
1.2.47 Before offering prophylactic antibiotics, ensure that the person has had:
• sputum culture and sensitivity (including tuberculosis culture), to identify other
possible causes of persistent or recurrent infection that may need specific treatment
(for example, antibiotic-resistant organisms, atypical mycobacteria or Pseudomonas
aeruginosa)
• training in airway clearance techniques to optimise sputum clearance (see
recommendation 1.2.99)
• a CT scan of the thorax to rule out bronchiectasis and other lung pathologies. [2018]
1.2.48 Before starting azithromycin, ensure the person has had:
• an electrocardiogram (ECG) to rule out prolonged QT interval and
• baseline liver function tests. [2018]
1.2.49 When prescribing azithromycin, advise people about the small risk of hearing
loss and tinnitus, and tell them to contact a healthcare professional if this
occurs. [2018]
1.2.50 Review prophylactic azithromycin after the first 3 months, and then at least
every 6 months. [2018]
1.2.51 Only continue treatment if the continued benefits outweigh the risks. Be aware
that there are no long-term studies on the use of prophylactic antibiotics in
people with COPD. [2018]
1.2.52 For people who are taking prophylactic azithromycin and are still at risk of
Chronic obstructive pulmonary disease

27
Q

When should oral theophylline be used?

A
  • only after a trial of SABAs and LABAs or for people who are unable to use inhaled therapy
  • caution in elderly
28
Q

When should assessment for long term oxygen therapy be considered?

A
  • very severe FEV1 < 30%
  • severe airflow obstruction FEV1 30-49%
  • cyanosis (blue tint to skin)
  • polycythaemia
  • peripheral oedema
  • a raised jugular venous pressure
  • o2 sats <92%

*Do not offer long-term o2 therapy to people who continue to smoke despite being offered smoking cessation advice and treatment

29
Q

How many hours a day should o2 therapy be breathed?

A

15 hours a day

30
Q

What needs to be considered when discharging a patient who has had a COPD exacerbation? (6)

A
  1. Carbocysteine - use if helps symptoms
  2. Refer for pulmonary rehabilitation
  3. change medicines back to inhalers not nebs
  4. 2 week follow up appointment with nurse
  5. rescue pack of oral steroids
  6. ensure vaccinations have been done and stop smoking
31
Q

LAMAs

A

tiotropium

32
Q

LABA

A

salmeterol, formoterol

33
Q

What is the brand name of tiotropium?

A

spiriva (LAMA)

34
Q

What is the brand name of aclidinium?

A

Eklira (LAMA)

35
Q

What LABAs are licensed for COPD?

A

Salmeterol, formoterol, (indacaterol),(olodaterol)

36
Q

What ICS/LABAs are licensed in COPD?

A

Fostair, Symbicort, Duoresp, Seretide*, Revlar

37
Q

What treatment should be offered initially if patient has no asthmatic features?

A

LABA + LAMA (this is because the patient does not respond to steroids if no asthmatic features)

38
Q

What are some antimuscarinic side effects?

A

dry mouth
constipation
dilation of pupils
dry skin

39
Q

What vaccinations are recommended in COPD?

A
  • flu

- pneumococcal

Patient PCP (15 decks)

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