Lecture 20 Flashcards
What do we do in terms of COPD?
Try to prevent the disease, but then we try to cure it. Then if not curable, we try to restore function. Then if we can’t do that then we concentrate on palliative care (the quality of life).
What are the effects of the disease?
The changes in spirometry occur prior to symptoms. As disease progresses you need to think about disability. FEV of 35% is a disability.
What is the value of peer support?
It is very important i.e. alcoholic anonymous. It is in terms of changing patients behaviour.
Describe the risks assessment criteria?
The social determinants, become increasingly important. Psychological issues are heavily relatable to peoples ability to self-manage.
What is COPD characterised by?
Air-flow limitation that is not fully reversible, usually progressive and associated with neutrophil infiltration with the airway - in correlation to noxious particles and gases (smokers, coal dust, pollution, biomass fuels).
Describe the spirometric evidence for obstruction?
The main change is in FEV1, so the ratio falls. Lung fibrosis, the main change is in lung volume. Lots of airways within the lung that close as you breathe out. The concavity of the expiratory loop (airways are collapsing, due to loss of elasticity and mucosal inflammation). COPD closes large number of airways, earlier than normal breathing. Someone with COPD has the tidal breathing at the top of the curve, and less change in volume for more pressure. Having to breathe high up int the lung volume, means increased work of breathing.
What is the distinction between asthma and COPD?
Asthma develop chronic airflow obstruction, starts one early life and completely reversible. COPD is usually due to noxious gases and appears around 50-60years at life.
What are the risk factors for COPD?
Genes, exposure to smoke, prematurity (babies that were born prem). Common in lower socio-economic groups, related to nutrition, co-morbidities, decrease in exercise (decrease in muscle strength).
What is the diagnosis of COPD?
C - confirm diagnosis. O - optimise management. P - prevent deterioration. D - develop self-management plan. X - manage exacerbations.
Describe the COPD severity?
Mild - 60-80%.
Moderate - 40-69%.
Severe -
Describe hypoxia?
Lack of oxygen regardless of cause or site, it effects the tissue level. there is increased cardiac and respiratory rates, mental deterioration and sometimes cyanosis. Some people have hypoxia without hypercapnia. People who can’t maintain sufficient alveolar ventilation get hypercapnia as well as hypoxia.
Describe treatments for COPD?
Quit programmes are important - i.e. quit smoking. Peer support groups are very important for patients with COPD. Referral to a specialist (diagnostic problems - co-morbidities i.e. heart failure). If someone is chronically hypoxic they qualify for long-term home oxygen. Inhaled bronchodilators, oral glucocorticoids.
