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- aai; clinical & pharmacy practice > COPD: Diagnosis And Treatment > Flashcards

COPD: Diagnosis And Treatment Flashcards

1
Q

What is COPD?

A 
Chronic Obstructive Pulmonary Disease:
Characterised by:
- Progressive airflow obstruction
- Neutrophilic inflammation
- Irreversible disease
- No cure
- Predominantly caused by smoking
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2
Q

How do you calculate pack years?

A

(No. smoked per day X No. years smoked)/20

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3
Q

What causes/risk factors associated with COPD?

A

Smoking.

  • Age (> 35 years)
  • Gender
  • Occupation (builders etc.)
  • Genetic factors (deficiency of alpha-1 adrenoceptors/trypsin enzyme)
  • Air pollution
  • Socio-economic status (poorer more likely to smoke)
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4
Q

What is the pathophysiology (observed change to physiology) of COPD?

A

Chronic Bronchitis:
- Inflammation of airways; w/e narrowing + mucus hypersecretion

Emphysema
- Destruction of alveoli (membranes break down and lose elasticitiy), airways collapse, hyperinflation of lungs (interfering with expulsion of air); ‘dead’ air gets trapped in lungs thus shallow breathing

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5
Q

What may result from gas exchange abnormalities?

A 
Hypoxia (deficiency of oxygen)
Respiratory acidosis (hence increased levels of CO2 in blood which decreases blood pH)
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6
Q

How is COPD diagnosed?

A

No single test:

Clinical judgement:

  • Patient history (>35 years/smoking)
  • Physical examination (signs and symptoms)
  • Spirometry
  • X-ray (rule out lung cancer)
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7
Q

What are the symptoms of COPD?

A
  • Chronic cough (usually 1st symptom; often ignored as patient thinks it’s smoker’s cough)
  • Breathlessness when exerting themselves (even when at rest)
  • Regular sputum production (observed in half of smokers; change in colour to yellow/green means infection)
  • Frequent winter chest infection
  • Wheeze
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8
Q

What other diseases share COPD’s symptoms and how would you rule them out?

A
  • Rapid weight loss/waking up at night/pyrexia (TB)
  • High BMI (obesity)
  • Fatigue/chest pain/raised blood pressure (CVD)
  • Pyrexia (infection)
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9
Q

What are the signs of COPD?

A
  • > 35 years of age/onset of symptoms in later life
  • Hyperinflated chest (trapped air)
  • Wheeze/quiet breath sounds
  • Pursed-lip breathing
  • Peripheral oedema
  • Cyanosis (blue tinge to skin due to lack of O2)
  • Clubbing of nails (swollen)
  • Nicotine staining of fingers and nails
  • Underweight
  • Use of accessory muscles (clinging onto edges with hands etc.)
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10
Q

What are the two characteristic groups of COPD?

A

Pink Puffers: emphysema

Blue Bloaters: bronchitis

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11
Q

How is COPD considered a systemic disease rather than a respiratory?

A
  • Pulmonary hypertension
  • Muscles weakeness
  • Osteoporosis (from steroid treatment)
  • Depression (mental health)
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12
Q

How is spirometry important with regards to COPD diagnosis?

A

Spirometry measures patient lung function.

- If the FEV1/FVC ratio is

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13
Q

What is FEV1?

A

Forced expiratory volume in one second

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14
Q

What is FVC?

A

Forced vital capacity - the maximum volume of air that ca be exhaled from the lung

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15
Q

When is spirometry testing performed with COPD?

A
  • At the time of diagnosis

- To reconsider diagnosis after response to treatment

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16
Q

What are the aims of COPD treatment?

A

COPD is incurable; only smoking cessation reduces FEV1 decline, drugs treat the symptoms.

  • Prevent and control symptoms (drug therapy)
  • Reduce frequency and severity of exacerbations
  • Improve quality of life
  • Improve exercise tolerance
  • Prevent disease progression
  • Minimise side effects
17
Q

What is the NICE guideline for COPD treatment for an FEV1 > 50%?

A

1.) SABA or SAMA as required
2.) LABA or LAMA (discontinue SAMA)
[after LABA > LABA + ICS (inhaled corticosteroid)]
3.) LAMA + LABA + ICS (triple therapy)
4.) Theophiline

18
Q

What’s the difference in dose frequency between a LABA and a LAMA and what devices are they?

A

LABA: Salmeterol pMDI (BD)
LAMA: Tiotropium dry powder (OD) - more convenient(?)

19
Q

What is the difference in NICE guideline COPD treatment for an FEV1 50%?

A

Go straight to LABA + ICS instead of just LABA.

20
Q

What should be considered before stepping up therapy?

A
  • Patient’s inhaler technique (correct usage?)
  • Adherence to therapy (actually using the inhaler?)
  • Smoking status (cessation pls)
  • Attendance at pulmonary rehabilitation (exercises that improve breathing)
  • Signs of anxiety or depression
21
Q

Name a commonly used SABA.

A

Salbutamol/terbutaline

22
Q

Name a commonly used SAMA.

A

Ipratropium

23
Q

Name a commonly used LABA

A

Salmeterol/formoterol/indacaterol

24
Q

Name a commonly used LAMA

A

Tiotropium/aclidinium/glycopyrronium

25
Q

How do ICS’ (inhaled corticosteroids) work and when are they used?

A
  • Reduce eosinophilic inflammation (only arises w/exacerbations as COPD is primarily neutrophilic inflammation)
  • Of benefit if FEV1
26
Q

What are the side effects associated with ICS use?

A
  • Pneumonia
  • Adrenal suppression (adrenal gland normally makes the body steroids)
  • Diabetes
  • Osteoporosis (brittle bones prone to fracture rising from steroid usage)
27
Q

When would oral bronchodilators be used and how do they work?

What are the pharmacokinetic issues?

A
  • Theophylline, last line treatment after ‘triple therapy’ used when all other steps exhausted.
  • Anti-neutrophilic inflammation activity
  • HOWEVER v.narrow therapeutic window (requires loading dose first to get it up to it) thus plasma levels need to be monitored
  • Smokers possess more of the enzyme to metabolise it; give higher dose
  • Elderly are more sensitive to it; give lower dose
28
Q

When is long-term oxygen therapy (LTOT) considered and what conditions are required for efficacy?

A
  • When PaO2 (partial pressure in arteriole blood)
29
Q

What other therapies exist for COPD?

A

Vaccinations

  • Pneumococcal
  • Influenza

Pulmonary rehabilitation
- Structured exercise therapy (improves aerobic function)

Mucolytics (aid clearance of mucus)
- e.g. Carbocisteine (reduces frequency of exacerbations and used as add-on to bronchodilators)

30
Q

What is an exacerbation of COPD the symptoms of?

A
  • Increase in eosinophil numbers (normally neutrophilic inflammation)
  • Worsening breathlessness
  • Cough
  • Increased sputum production
  • CHange in sputum colour (to green/yellow)
  • Worsening peripheral oedema

“Sustained worsening of patient’s symptoms from usual state that is beyond normal day-to-day variations and is acute in onset”

31
Q

How are exacerbations managed?

A
  • Increase bronchodilator frequency/usage
  • Oral corticosteroids; prednisolone 30mg/day for 7 to 14 days
  • Antibiotics: aminopenicillin/macrolide/tetracycline
  • Oxygen

(Rescue packs exist where patient has short-term steroids/antibiotics they can start on before seeing GP)

- aai; clinical & pharmacy practice (4 decks)

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