Craven Flashcards
What does Mr Craven’s patient profile tell us?
Has a 30-pack year smoking history
Grew up in Glasgow, both parents were smokers
Works as a British Gas plumber, work has reduced hours these days
A huge fan of the Glasgow rangers
Had a chest infection recently and took amoxicillin
Took his wife to the cinema for their wedding anniversary
Enjoys fly fishing accompanied by his wife
What does Mr Craven talk about in the Case video?
Breathing gotten a lot worse over the last few days Can't get enough air in Chest feels tired, achy Having difficulty sleeping at night Last night had to get blue puffer out at least 4x during the night Coughing up more phlegm and sputum than normal - a few egg cup fulls a day Yellow green coloured sputum No blood in sputum No wheezing, 'rattling' No chest tightness No chest pain Diagnosed with COPD 3 years ago On a good day - 15 mins to shop Stairs - can manage a flight but but of breath getting to the top Claims he hasn't taken antibiotics or oral steroids from the GP in the last year No other medical problems Off food for last few days - soups Just him and his wife He's gonna be a grandpa (has a daughter) Swelling in both ankles Feeling flushed Waterworks and bowel movements okay No recent faints / unconsciousness Quit smoking when he got the COPD diagnosis Used to smoke a pack a day for 40 years On blue puffer and special combo inhaler No drug allergies
What does the doctor think Mr Craven has after taking his history?
Effective exacerbation of your COPD
What does the doctor want to do next?
Examine Mr Craven, listen to his chest, run some blood tests, get a chest x-ray (CXR), get an ECG, sputum analysis
Arterial blood gas test - O2 sats low at 87
What is Chronic Obstructive Pulmonary Disease (COPD)?
Name for a group of lung conditions that cause breathing difficulties:
Emphysema – damage to the air sacs in the lungs
Chronic bronchitis – long-term inflammation of the airways
What are the main symptoms of COPD?
Increasing breathlessness, particularly when active
Persistent chesty cough with phlegm – some people may dismiss this as just a “smoker’s cough”
Frequent chest infections
Persistent wheezing
When is it good to get medical advice?
Persistent COPD symptoms, esp. if 35+ and smoke / used to smoke
Why is it important not to ignore COPD symptoms?
Best to start treatment ASAP before lungs get significantly damaged
What are the causes of COPD?
Long term exposure to dust or harmful fumes
Smoking
Rare genetic problem = lungs more vulnerable to damage
All lead to inflamed, damaged and narrowed lungs (aKA COPD)
What are the treatments for COPD? Why are they important / useful?
Damage to lungs caused by COPD is permanent but treatment can help slow down the progression of the condition
Treatments include:
Stop smoking
Inhalers and medications - help breathing
Pulmonary rehabilitation - specialised exercise and education programme
Surgery / lung transplant
What else may be required by someone with COPD?
Social care and support
Need help for daily tasks
Or they may be a carer
How can you reduce the chance of developing COPD?
Avoid smoking
What did COPD used to be known as?
Chronic bronchitis and emphysema
Affects lung tubes, air tubes and the lung tissue itself
How is COPD defined clinically?
Coughing up mucus every day, for 3 months of the year, typically in the winter
What is the progression of COPD?
Persistent smoker’s cough
Coughing up phlegm / sputum / mucus
Breatlessness on exertion
How to diagnose suspected COPD?
CXR (chest x-ray)
Blow test - measures lung function compared to average
What are the typical treatments prescribed by the GP for COPD patients?
Inhaler to to open up air passages during spasms / coughing
Inhaler to reduce inflammation
Emergency supply of antibiotics = do not need to wait for prescription if they develop a chest infection
What are some other less common symptoms of COPD?
Weight loss
Tiredness
Swollen ankles from a build-up of fluid (oedema)
Chest pain and coughing up blood – although these are usually signs of another condition, such as a chest infection or possibly lung cancer
Only tend to happen with COPD reaches advanced stage
What other conditions cause similar symptoms to COPD?
How can you differentiate between them?
Asthma, bronchiectasis, anaemia, heart failure
Breathing test can help determine if you have COPD
What are the causes of COPD?
Smoking - 9 out of 10 cases: harmful chemicals damage lining of lungs and airways
Passive smoking
Fumes and dust at work - damage lungs:
cadmium dust and fumes
grain and flour dust
silica dust
welding fumes
isocyanates
coal dust
Air Pollution
Exposure over a long period can affect how well the lungs work (inconclusive evidence)
Genetics
1 in 100 with COPD have tendency to develop a genetic condition called Alpha-1-antitrypsin deficiency. Alpha-1-antitrypsin = substance that protects your lungs
What might a GP do to confirm a diagnosis of COPD?
Ask about symptoms
Examine chest and listen to breath sounds
Ask about smoking history
Calculate BMI
Ask about family history of lung problems
Perform tests
What tests can help a GP confirm a diagnosis of COPD?
Spirometry - breathe into spirometer after inhaling a bronchodilator, record vol of air exhaled in 1st second and total vol of air exhaled. Compare results with baseline to check if lungs are obstructed
CXR (chest x-ray) - look for problems in the lungs that can cause similar symptoms to COPD e.g. cancer, chest infections
Blood test - show other conditions that can cause similar symptoms to COPD e.g. anaemia, polycythaemia. Sometimes done to look for alpha-1-antitrypsin deficiency
What are some further tests to determine severity of COPD?
Electrocardiogram (ECG) – a test that measures the electrical activity of the heart
Echocardiogram – an ultrasound scan of the heart
Peak flow test – a breathing test that measures how fast you can blow air out of your lungs, which can help rule out asthma
Blood oxygen test – a peg-like device is attached to your finger to measure the level of oxygen in your blood
CT scan – a detailed scan that can help identify any problems in your lungs
Phlegm sample – a sample of your phlegm (sputum) may be tested to check for signs of a chest infection
What are the available treatments for COPD?
Stop smoking
Inhalers - device delivers medicine directly into lungs whilst breathing
Tablets
Antibiotics
Pulmonary rehabilitation
Nebulised medicine - machine turns liquid medicine into mist and is breathed in through a mouth piece = larger dose delivered at a time
Roflumilast - new medication for flare ups to reduce inflammation
Long-term O2 therapy - >16hrs/day
Ambulatory oxygen therapy = blood O2 normal at rest, but falls on exertion
Non invasive ventilation = portable machine connected to mask to support lungs
Surgery
What are the different types of inhalers prescribed for COPD?
Short-acting bronchodilator inhalers - first treatment use:
Beta-2 agonist inhalers - e.g. salbutamol and terbutaline
Antimuscarinic inhalers e.g. ipratropium
Used up to 4x a day, only when feeling breathless
Long-acting bronchodilator inhalers - if symptoms persist throughout the day, use:
Beta-2 agonist inhalers e.g. salmeterol, formoterol and indacaterol
Antimuscarinic inhalers e.g. tiotropium, glycopyronium and aclidinium
Last up to 12 hours, should only be used 1-2x a day
Steroid inhalers - if still breathless or frequent exacerbations use:
corticosteroid medicines to reduce Inflammation in the airways
What so combination inhalers often include?
Steroid inhalers
Long-acting medicine
What are the different tablets prescribes for COPD?
Theophylline tablets - bronchodilator, reduces inflammation in the airways and relaxes the muscles lining them
Mucolytics - e.g. carbocisteine 3-4x a day = makes phlegm in the throat thinner and easier to cough up
Steroid tablet - for bad exacerbations to reduce inflammation = 5 day course though long term use = weight gain, mood swings, weakened bones (osteoporosis)
What is pulmonary rehabilitation?
Specialised programme of exercise and education: involving:
Physical exercise training tailored to your needs and ability – such as walking, cycling and strength exercises
Education about your condition for you and your family
Dietary advice
Psychological and emotional support
What are the side effects of Roflumilast?
Side effects of roflumilast include:
feeling and being sick
diarrhoea
reduced appetite
weight loss
headache
What are the surgical treatment options for COPD?
Bullectomy – remove pocket of air from one of the lungs, allowing the lungs to work better and make breathing more comfortable
Lung volume reduction surgery – an operation to remove a badly damaged section of lung to allow the healthier parts to work better and make breathing more comfortable
Lung transplant – an operation to remove and replace a damaged lung with a healthy lung from a donor
What should a patient living with COPD do?
Look after themselves
Take their prescribed medication and refer to info leaflets for flare ups
Stop smoking
Exercise regularly
Maintain a healthy weight - carrying extra weight makes breathlessness worse
Get vaccinated - COPD = strain on body = vulnerable to infections
Check weather - symptoms temperamental so prep in advance w/ extra medication
Watch what you breath - avoid dust, fumes, smoke, air freshners, strong smelling cleaning products, hairspray, perfume
Regular reviews and monitoring with care team
Practice breathing techniques - slow deep breaths
Talk to others - GP, local support group, counsellor, psychologist
Relationships - difficulty breathing = tired and depressed
Sex = strenous, sex life affected
Flying with COPD = take medications in hand luggage
Finance - entitled to statuatory sick day and employment & support allowance; carer entitled to carer’s allowance
End of life care - management plan based on your wishes (advance decisions made)
What are some co-morbidities (with COPD) that could contribute to Mr Craven’s current shortness of breath?
CVD - chronic heart failure, CAD, PAD, atrial fibrillation
Asthma
Anaemia
Anxiety / Depression - closely related to the risk of death
Respiratory infections
Cancer - oesophageal, pancreatic, breast, lung = also closely related to risk of death often due to COPD population being smokers
Hypertension
Diabetes
Chronic Renal Failure
Degenerative joint disease
Why are COPD exacerbations so serious?
Many patients die within 1 year of their first COPD exacerbation
Lung function decline Lessened physical activity Poor / declining mental Health Deterioration in quality of life Further COPD exacerbations Mortality
