COPD CUE CARDS Flashcards
What is COPD? What is it Characterised by?
> Airflow limitation that’s not fully reversible
> Airway inflammation (often driven off tobacco use)
> Breathlessness during physical activity
> Daily cough with or without sputum
What is COPD Caused by?
> Small airway narrowing (+/- chronic bronchitis) and emphysema
> Chronic bronchitis: daily sputum production for at least 3 months of 2 or more consecutive years
> Emphysema consists of alveolar dilation and destruction which reduces surface area for gas exchange
What is the SAME between asthma and COPD?
Both conditions involve inflammation of the airways
What are the DIFFERENCES between asthma and COPD?
> Asthma predominantly involves constriction of the airway smooth muscle
> COPD involves airway fibrosis and alveolar destruction - explains why airway limitation is not considered to be reversible
What is airflow limitation due to?
> Airflow limitation is due to inflammation, fibrosis and remodelling of peripheral airways
> As a result, is irreversible with bronchodilators
> Results in non homogenous ventilation and air trapping
The loss of lung elastic tissue in emphysema may result in what?
> May result in airway wall collapse during expiration
> Causes dynamic hyperinflation
> Results in increased work of breathing
What is diagnosis based on?
> Symptoms
Risk factors (e.g. hx of smoking or exposure to noxious agents -e.g. dust)
Spirometry (FEV1/FVC < 0.7 post-bronchodilator) - but not the best way to manage disease
What are the treatment aims in COPD?
Most drug therapy is about optimising function but we have limited efficacy for prevent deterioration
What is the most effective strategy to prevent deterioration?
The most effective strategy to prevent deterioration is smoking cessation
How is COPD Managed?
COPDX Plan
What is COPDX Plan?
> Confirm diagnosis > Optimise function > Prevent deterioration > Develop a self-management plan > Manage exacerbations (characterised by change in patient's: baseline dyspnoea, cough and/or sputum beyond normal day-to-day variation, acute in onset)
Discuss a patients predicted curve
> Quick release of air in the lungs
In a patient with COPD, the air comes out much slower because of the collapse in the airways (this means that when patients exercise, you breath in more deeply, when you exhale, normally you would exhale most of the extra air breathed in. But because these patients expel air more slowly, they don’t get rid of extra air breathed in - trapped air in the lungs)
What is the role of bronchodilators in COPD?
> May provide symptom relief and may increase exercise capacity
> May not produce significant changes on spirometry
What bronchodilator is preferred intitally?
> Salbutamol preferred initially
> Faster onset of action and fewer risks
> Ipratropium associated with CV risks and anticholinergic S/Es include dry mouth and urinary retention
What do bronchodilators assist with in hyperinflation?
> Bronchodilators help to relieve the air trapping in COPD that causes hyperinflation of the lungs
> The hyperinflation of the lungs is a major stimulus for the symptoms of SOB
> By improving expiration, even slightly, this helps to reduce the air trapping
> Results in significant improvements in symptoms (less SOB because reducing hyperinflations, not reflected in FEV1)
