M103 T4 L10 Flashcards
What are the physical signs of COPD?
Barrel-shaped chest (hyperresonant) percussion Accessory muscles Prolonged expiration Pursed-lip breathing Tripod position Low BMI Nicotine-staining
What are the physiological effects of COPD?
Increased work of breathing
Reduced Exercise Tolerance
Impaired gas exchange
What are the physioloical effects of COPD?
Hypoxia Hypercapnia Raised pulmonary artery pressure RV dilatation, cor pulmonale Loss of Fat Free Mass
How are chronic diseases managed?
stop smoking inhalers flu vaccination educate and empower treat exacerbations pulmonary rehabilitation healthy BMI (LTOT)
How often are pulmonary rehabilitation meetings?
two supervised sessions for six weeks
What is focused on in pulmonary rehabilitation meetings?
Education
Psychosocial support/group work
supervised exercise training
What are other treatments for COPD?
Theophylline
Azithromycin
Lung volume reduction surgery
Lung transplantation
What additional therapy is used to treate the acute deterioration in symptoms of COPD?
Mild - SABA
Moderate - SABA +/- steroids +/- antibiotics
Severe - hospital admission or ED attendance
What conditions would require the patient to attend ED?
progressive dyspnoea/hypoxia
signs of infection
signs of r. HF
How is severe exascerbation of COPD treated?
Antibiotics if signs of infection (sputa results)
Oral steroids
Target saturations 88-92% (controlled oxygen)
Nebulisers (bronchodilate)
Consider diuretics
Nicotine replacement therapy/refer for smoking cessation
When would non invasive ventilation be used to treat COPD?
if decompensated hypercapnic respiratory failed despite controlled oxygen and nebulised treatments
When would invasive mechanical ventilation be used to treat COPD?
if respiratory failure occured despite nebulised therapy and controlled oxygen
if the patient is unable to tolerate NIV
When would palliate care be used to treat COPD?
if there had been respiratory failure on background of significant progressive decline over several months/years with no evidence of reversible event
How are COPD symptoms controlled? (LOFT, COT)
Lorazepam
Oromorph
Fan Therapy
CBT, Oxygen Therapy
Pacing/Breathing strategies
Hospice input
What are the features of chronic bronchitis?
a chronic productive cough for three months in two successive years
excludes other causes of chronic cough
What are the features of emphysema? What is it caused by?
abnormal and permanent enlargement of the airspaces due to destruction of the alveolar airspace walls
What is a symptom of small airways disease?
wheezing
What are the three factors required to diagnose a patient with COPD?
symptoms
risk factors
spirometry
Which symptoms can be used to contribute to a COPD diagnosis?
exertional breathlessness
productive cough
winter bronchitis
wheeze
Which risk factors can be used to contribute to a COPD diagnosis?
at least 20 a day for 10 years
smoking history
older than 35 years
What must the FEV1/FVC value be to contribute to a COPD diagnosis?
FEV1/FVC <0.7
Which inhaler combination is used for symptomatic COPD patients?
LAMA
LABA
How often is azithromycin administered?
3 times a week
What conditions does Azithromycin treat?
bacterial infections, malaria and COPD
What are features of “blue bloaters”?
patients with chronic bronchitis who present with cyanosis
they take deeper breaths but can’t take in the right amount of o2
What are features of “pink puffers”?
patients with severe emphysema who present with pink tinged skin, shortness of breath and pursed lip breathing
