Lec 43-COPD Flashcards
Definition
- Chronic Obstructive Pulmonary Disease (COPD) is characterised by airflow obstruction
- The airflow obstruction is usually progressive, not fully reversible and doesn’t change markedly over several moths
- The disease is predominately caused by smoking
Disease pathology 1
-Chronic (long term) Obstructive (narrowing of airways) Pulmonary (affects lungs) Disease (medical condition)
-Bronchitis means the airways are inflamed and narrowed people with bronchitis often produce sputum or phlegm
-Emphysema affects the airsacs at the end of the airways of the lungs. They breakdown and the lungs become baggy and full of holes which trap air
-The process narrow the airways, making it harder to move air in and out as you breathe
+The lung tissue is damage so there is less pill on the airways
+Elastic lining of the airways flops
+Airway lining is inflamed
Disease Pathology 2
- Most likely to develop COPD if >35 yrs and are or have been a smoker
- Jobs where people are exposed to dust, fumes and chemicals can also contribute to developing COPD
- Some people are more affected than others by breathing in noxious materials. You have higher risk if respiratory problems
- Rare genetic condition called alpha-1-antitrypsin deficiency makes people very susceptible to develop COPD at a young age
Normal lung function
Forced Expiratory Volume (FEV
- Lower for restrictive disease
- Even lower for obstructive
Demographics
- An estimated 1.2 million people are living with diagnosed COPD
- The number of people who have ever had a diagnosis of COPD has increased by 27% in the last decade
- Prevalence increased by 9% between 2008-12
- Throughout the year 2004-12, proportions of the population with diagnosed COPD were always higher among males than females. 2012 10% more males than female
- 2012, 29,776 people died form COPD (5.3% of deaths)
- Of these 15,245 were males and 14,531 were females . The total number of deaths was up from 28,344 in 2008
Signs and symptoms
- Getting short of breath easily when doing everyday things
- Having a cough that lasts a long time
- Wheezing in cold weather
- Producing more sputum or phlegm than usual
- You might get these symptoms all the time, or they might appear to get worse when you have an infection or breathe in smoke
- In severe COPD= loss of appetite, lose weight and ankle swelling
- COPD is different to asthma; in COPD airways are permanently narrowed and is irreversible
Diagnosing
-Spirometry
Risk factor- SMOKING
- Stop smoking- this is the only therapeutic approach other than O2 therapy
- NRT or bupropion (anti-depressant) or vareniclin (partial nicotine receptor agonist) as appropriate support
NICE guidelines- stable COPD
1) Short acting inhaled B-agonist (SABA) e.g. salbutamol or formoterol or short actin gmuscarninnc antagonist (SAMA) should be first line treatment e.g. ipratropium
2) Response not measure by lung function test alone- include daily living, patient perception and symptom relief
3) If still have breathlessness or exacerbations:
- If FEV1 >50% add LABA or add LAMA (remove SAMA)
- If FEV1 <50% use either LABA+ ICS in combined inhaler or LAMA
- See diagram on BB
Indacterol (LABA)
- New long acting sympathomimetic agent
- Single dose duration 24 hours- OD dosing
- LIcensed only for maintenance treatment of COP- not asthma
- Not tested in long term asthma therapy
- In COPD alternative to salmeterol or formeterol
Long acting Muscarnic antagonist (LAMA
- Sustained antagonism of muscarinic receptors: high receptor affinity
- Topically active and administered by inhalation
- Tiotropium powder or solution for inhalation
- Licensed only for maintenance treatment of COPD- no value in acute attack
- Must stop SAMA when using LAMA
LABA/ICS combinations
- Forstair: BEC 100 mag; Formoterol 6 mcg
- Symbicort: budesonide 100 mcg
- If ICS not tolerated or decline an alternative option is to combine LABA and LAMA e.g. formeterol with Tiotropium
Inhaler delivery system
- Quality statement 2: Inhaler technique
- Hand held best if can be used. Consider spacer
- MDI 1st option but can try other inhaler types
- Spacers must be compatible with inhaler and do not over clean
- Nebulisers when patients disabled by breathlessness despite Max use of inhalers
- Review and don’t continue without evidence of benefit
Steroid therapy
- Oral steroids are not advised. In advanced COPD may need low dose oral maintenance- dose as low as possible. Watch for SE
- ICS not licensed for use alone in COPD- prescribers responsible
- Oral reversibility tests do not predict inhaled therapy responses and shouldn’t ne used
- ICS are to reduce progression of disease and control exacerbations not to improve lung function
- Risk of osteoporosis and other side effects with long term high dose ICS
Theophylline
- No longer recommended- narrow therapeutic index- toxicity
- Should only be used for patients that cannot use inhaled therapy or if symptoms persist
- Offer only after trials of SABA and LABA
- Can be combined with B-agonists and muscarinic antagonist
- No advantage over SABA or LABA and poor side effect profile, need to monitor plasma level interactions
