CSI 4 - Breathlessness Flashcards
What is chronic obstructive pulmonary disease? (COPD)
COPD is a name for a group of lung conditions that cause breathing difficulties, including emphysema and chronic bronchitis
Give brief descriptions of emphysema and chronic bronchitis.
- emphysema - damage to the air sacs in the lungs
- chronic bronchitis - long-term inflammation of the airways
What are the main symptoms of COPD? (4)
- shortness of breath, particularly when active
- persistent chesty cough with phlegm - some may dismiss this as just a ‘smoker’s cough’
- frequent chest infections
- persistent wheezing
What are COPD flare-ups/exacerbations?
Periods when symptoms get suddenly worse
When should you get medical advice for COPD?
See a GP if you have persistent symptoms of COPD, particularly if you are over 35 and smoke/used to smoke
What can the GP do after asking about your symptoms and whether you smoke or have smoked in the past?
Organise a breathing test to help diagnose COPD and rule out other lung conditions such as asthma
What is the main cause of COPD, and some other causes? (3)
- main - smoking
- long-term exposure to harmful fumes or dust
- rare genetic problem (alpha1 antitrypsin deficiency) that makes lungs more vulnerable to damage
What happens to the lungs in COPD?
COPD happens when the lungs become inflamed, damaged and narrows
Is damage to the lungs caused by COPD temporary or permanent?
Permanent - but treatment can help slow down the progression of the condition
What are some treatments for COPD? (4)
- stopping smoking - if you have COPD and you smoke, this is the most important thing you can do
- inhalers and medicines - to help make breathing easier
- pulmonary rehabilitation - a specialised programme of exercise and education
- surgery or lung transplant - only an option for a very small number of people
When is social care and support needed for COPD?
- if you need help with day-to-day living because of illness or disability
- if you care for someone regularly because they are ill, elderly or disabled (including family members)
How do you go about preventing COPD?
Avoid smoking / stop smoking if you already do
What are some less common symptoms of COPD (often at advanced stage)? (4)
- weight loss
- tiredness
- swollen ankles from build-up of fluid (oedema)
- chest pain and coughing up blood - although these are usually signs of another condition e.g. chest infection/lung cancer
What tests are used to diagnose COPD? (4)
- spirometry
- chest X-ray (rule out other conditions)
- blood tests (rule out other conditions/look for A1AT deficiency)
- further tests e.g. ECG, echocardiogram, peak flow test, blood oxygen test, CT scan, phlegm sample
What are three types of inhalers used to manage COPD (in order of severity)?
- short-acting bronchodilator inhalers
- long-acting bronchodilator inhalers
- steroid inhalers
What are the two types of short-acting bronchodilators?
- beta-2 agonist inhalers - salbutamol and terbutaline
- antimuscarinic inhalers - ipratropium
What are the two types of long-acting bronchodilators?
- beta-2 agonist inhalers - salmeterol, formoterol and indacaterol
- antimuscarinic inhalers - tiotropium, glycopyronium and aclidinium
- some new inhalers contain a combination of a long-acting beta-2 agonist and antimuscarinic
What are the types of tablets used to manage COPD? (4)
- theophylline tablets - bronchodilator
- mucolytics (carbocisteine) - makes phlegm thinner
- steroid tablets
- antibiotics
What other treatment options are there? (5)
- nebulised medicine
- Roflumilast
- long-term oxygen therapy
- ambulatory oxygen therapy
- non-invasive ventilation
Describe the COPD exacerbation and how this could lead to mortality.
- COPD exacerbation
- decreased lung function
- decreased physical activity
- decreased mental health
- decreased QoL
- further COPD exacerbations
- mortality
What are some of the comorbidities associated with COPD?
- hypertension
- hyperlipidaemia
- atrial fibrillation
- CAD
- breast cancer, anxiety
- CHF, CVA, PAD
- lung cancer, pulmonary fibrosis, pulmonary hypertension, OSA
- diabetes, erectile dysfunction, BPH, CRF, DJD, GERD, gastric duodenal ulcer, diabetes with neuropathy, liver cirrhosis, oesophageal cancer
- depression, substance abuse
How does the severity of COPD change with number of comorbidities?
The more comorbidities, the more severe the patient’s COPD
How do you assess image quality in chest X-rays (RIPE)?
- R - rotation
- I - inspiration (how many ribs seen?)
- P - projection (AP or PA? usually PA)
- E - exposure
What is the ABCDE approach to chest X-rays?
- A - airway (trachea central? bronchi branching?)
- B - breathing (lung fields, lung markings - normal)
- C - cardiac (heart size and borders) / consolidation (any white opacities, compare right and left upper, middle and lower zones)
- D - diaphragm (costophrenic angle where it meets lung)
- E - everything else (bones, ribs, clavicle, fractures, tubes, pacemakers)
