COPD Flashcards
What are the features of COPD?
cough: often productive
dyspnoea
wheeze
in severe cases, right-sided heart failure may develop resulting in peripheral oedema
What will post-bronchodilator spirometry to demonstrate?
airflow obstruction: FEV1/FVC ratio less than 70%
What will CXR demonstrate?
hyperinflation
bullae: if large, may sometimes mimic a pneumothorax
flat hemidiaphragm
also important to exclude lung cancer
Why is an FBC performed in COPD?
exclude secondary polycythaemia
How is the severity of COPD is categorised?
using the FEV1
What is Stage 1 COPD
Stage 1 - Mild
< 0.7 FEV1/FVC
> 80% FEV1 (of predicted)
What is Stage 2 COPD
Stage 2 - Moderate
< 0.7 FEV1/FVC
50-79% FEV1 (of predicted)
What is Stage 3 COPD
Stage 3 - Severe
< 0.7 FEV1/FVC
30-49% FEV1 (of predicted)
What is Stage 4 COPD
Stage 3 - End stage
< 0.7 FEV1/FVC
<30% FEV1 (of predicted)
How useful is PEF in COPD?
Measuring peak expiratory flow is of limited value in COPD, as it may underestimate the degree of airflow obstruction.
What are the causes of COPD?
Smoking!
Alpha-1 antitrypsin deficiency
Other causes cadmium (used in smelting) coal cotton cement grain
General management of stable COPD?
> smoking cessation advice: including offering nicotine replacement therapy, varenicline or bupropion
annual influenza vaccination
one-off pneumococcal vaccination
pulmonary rehabilitation to all people who view themselves as functionally disabled by COPD
What is the first line treatment of stable COPD?
SABA/SAMA
What is the second line treatment of stable COPD?
No asthmatic features/features suggesting steroid responsiveness LABA + LAMA
Asthmatic features/features suggesting steroid responsiveness
LABA + inhaled corticosteroid (ICS)
What is the third line treatment of stable COPD?
triple therapy i.e. LAMA + LABA + ICS
if already taking a SAMA, discontinue and switch to a SABA
What is the indication for prophylactic antibiotic therapy in COPD?
patients should not smoke, have optimised standard treatments and continue to have exacerbations
What is the reccomended for prophylactic antibiotic therapy in COPD?
azithromycin
What are the prerequisites for azithromycin treatment in COPD?
CT thorax (to exclude bronchiectasis) and sputum culture (to exclude atypical infections and tuberculosis) LFTs and an ECG to exclude QT prolongation (azithromycin can prolong the QT interval)
What factors improve survival in patients with stable COPD?
smoking cessation - the single most important intervention in patients who are still smoking
long term oxygen therapy in patients who fit criteria
lung volume reduction surgery in selected patients
What are the features of cor pulmonale?
peripheral oedema, raised jugular venous pressure, systolic parasternal heave, loud P2
What is the management for cor pulmonale?
loop diuretic for oedema (furosemide, bumetanide)
consider long-term oxygen therapy
What are the features of an acute exacerbations of COPD?
increase in dyspnoea, cough, wheeze
there may be an increase in sputum
patients may be hypoxic
in some cases have acute confusion
What are most common bacterial organisms that cause infective exacerbations of COPD?
Haemophilus influenzae (most common cause)
Streptococcus pneumoniae
Moraxella catarrhalis
What % of acute exacerbations of COPD are caused by viruses?
30%
rhinovirus being the most important pathogen
all patients with an exacerbation of COPD should receive antibiotics
false
oral antibiotics ‘if sputum is purulent or there are clinical signs of pneumonia’
How should acute exacerbations of COPD be managed?
increase frequency of bronchodilator use and consider giving via a nebuliser
give prednisolone 30 mg daily for 5 days
one of the following oral antibiotics first-line: amoxicillin or clarithromycin or doxycycline.
When should long-term oxygen therapy be offered in COPD patients?
pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following:
secondary polycythaemia
peripheral oedema
pulmonary hypertension
do not offer LTOT to people who continue to smoke despite being offered smoking cessation advice and treatment, and referral to specialist stop smoking services
true
risks of falls from tripping over the equipment should be carried out before offering LTOT
true
also the risks of burns and fires, and the increased risk of these for people who live in homes where someone smokes (including e‑cigarettes)
What are oxygen saturation targets for acutely ill patients?
94-98%
patients at risk of hypercapnia (e.g. COPD patients): 88-92%
Outline emergency oxygen therapy for COPD patients
prior to availability of blood gases, use a 28% Venturi mask at 4 l/min and aim for an oxygen saturation of 88-92% for patients with risk factors for hypercapnia but no prior history of respiratory acidosis
adjust target range to 94-98% if the pCO2 is normal
Outline emergency oxygen therapy for acutely unwell patients (non-COPD)
initially be given via a reservoir mask at 15 l/min
94-98% target
