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2. Respiratory Medicine (Lectures) > Management of COPD > Flashcards

Management of COPD Flashcards

1
Q

What is COPD?

A

Chronic bronchitis or emphysema

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2
Q

What is chronic bronchitis?

A

Airway obstruction (narrow airways)

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3
Q

What is emphysema?

A

Hyperinflation (damaged alveoli making gas exchange more difficult)

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4
Q

What caused the airway to narrow?

A

Mucus builds up

Airway muscles tighten

Airway lining swells up (inflamation)

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5
Q

What are symptoms of COPD?

A

Breathlessness

Cough

Recurrent chest infection

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6
Q

What is the most common reason why people develop COPD?

A

Tobacco smoke

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7
Q

Why does tobacco smoke cause COPD?

A

1) Nicotine and oxygen free radicals in tobacco acts on neutrophils causing them to degranulate and inactivates anti-proteases
2) Releases neutrophil elastase inactivates anti proteases and causes tissue damage

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8
Q

What does tobacco smoke do to neutrophils?

A

Causes them to degranulate and release elastase

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9
Q

What does tobacco smoke do to anti-proteases?

A

Inactivates them

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10
Q

What does COPD cause not within the respiratory system?

A

Loss of muscle mass

Weight loss

Cardiac disease

Depression

Anxiety

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11
Q

How do you diagnose COPD?

A

Relevent history (symptoms)

Look for clinical signs

Confirmation of diagnosis and assessment of severity

Other relevent tests

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12
Q

When would you suspect COPD?

A

35 years or more

Current or former smoker

Chronic cough

Exertional breathlessness

Sputum production

Frequent winter bronchitis

Wheeze

Chest tightness

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13
Q

What is the difference in age between COPD and asthma?

A

COPD is generally older than 35

Asthma is any age

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14
Q

What is the difference between the cough due to COPD and asthma?

A

COPD cough is persistent and productive

Asthma cough is intermitten and non-productive

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15
Q

What is the difference between smoking in COPD and asthma?

A

COPD smoking is almost invariable

Asthma smoking is possible

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16
Q

What is the difference in breathlessness between COPD and asthma?

A

COPD is progressive and persistant

Asthma is intermittent and variable

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17
Q

What is the difference in nocturnal symptoms in COPD and asthma?

A

COPD is uncommon unless in severe distress

Asthma is common

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18
Q

What is the difference in family history in COPD and asthma?

A

COPD is uncommon unless family members also smoke

Asthma is common

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19
Q

What is the difference in allergies between COPD and asthma?

A

COPD is possible

Asthma is common

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20
Q

What is typically seen in a COPD examination?

A

May be normal in early stages

Reduced chest expansion

Prolonged expiration/wheeze

Hyperinflated chest

Respiratory failure

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21
Q

What is the chest expansion like in COPD?

A

Reduced

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22
Q

What is the inflation of the chest like in COPD?

A

Hyperinflated chest

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23
Q

What is the expiration like in COPD?

A

Prolonged/wheeze

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24
Q

What are signs of respiratory failure?

A

Tachypneoa

Cyanosis

Use of accessory muscles

Pursed lip breathing

Peripheral oedema

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25
Q

What is tachypneoa?

A

Abnormally rapid breathing

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26
Q

What is the process of the COPD diagnosis?

A

Clinical history (cough, breathlessness, chest infections, winter bronchitsis)

Examination (may be normal, tachypneoa, wheeze, hyperinflated chest)

Spirometry (confirms diagnosis and assesses severity)

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27
Q

What is used to confirm the diagnosis of COPD and assess the severity?

A

Spirometry

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28
Q

When is spirometry obstructive?

A

When FEV1/FVC is less than 70%

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29
Q

What are the different levels of COPD severity?

A

Mild (FEV1​ >80%)

Moderate (FEV1​ 50-79%)

Severe (FEV1​ 30-49%)

Very severe (FEV1​ <30%)

All values are relative to the predicted FEV1 (70% of FVC)

30
Q

When is COPD mild?

A

FEV1​ > 80%

31
Q

When is COPD moderate?

A

FEV1​ 50-79%

32
Q

When is COPD severe?

A

FEV1​ 30-49%

33
Q

When is COPD very severe?

A

FEV1​ < 30%

34
Q
A
35
Q

What are some COPD baseline tests?

A

Spirometry (record absolute and & of predicted values)

Chest X-ray

ECG

Full blood count

BMI (weight and height)

A1AT (alpha-1-antitrypsin if age of onset <50 years)

36
Q

When do you check alpha-1-antitrypsin (A1AT) levels?

A

When the age of onset is less than 50 years old

37
Q

What are the aims of COPD management?

A

Prevention of disease progression

Relieve breathlessness

Prevention of exacerbation

Management of complications

38
Q

How is prevention of disease progression obtained?

A

Smoking cessation

39
Q

How is relieving breathlessness obtained?

A

Inhalers

40
Q

How is prevention of exacerbations obtained?

A

Inhalers

Vaccines

Pulmonary rehabilitation

41
Q

How is management of complications obtained?

A

Long term oxygen therapy

42
Q

What are some non-pharmacological managements of COPD?

A

Smoking cessation

Vaccination

Pulmonary rehabilitation

Nutritional assessment

Psychological support

43
Q

What vaccinations help COPD?

A

Annual flu vaccine

Pneumococcal vaccine

44
Q

What are the benefits of pharmacological management?

A

Relieves symptoms

Prevent exacerbations

Improve quality of life

45
Q

What are different kinds of inhaled COPD therapies?

A

Short acting bronchodilators

Long activing bronchodilators

High dose inhaled corticosteroids and LABA

46
Q

What are examples of short acting bronchodilators?

A

SABA, short acting B2 agonist (salbutamol)

SAMA, short acting muscarinic antagonist (ipratropium)

47
Q

What is an example of a short acting B2 agonist (SABA)?

A

Salbutamol

48
Q

What is an example of a short acting muscarinic antagonist?

A

Ipratropium

49
Q

What are examples of long acting bronchodilators?

A

LAMA, long acting muscarinic antagonist (umeclidinium and tiotropium)

LABA, long acting B2 agonist (salmeterol)

50
Q

What are examples of long acting muscarinic antagonists?

A

Umeclidinium and tiotropium

51
Q

What are examples of long acting B2 agonists?

A

Salmeterol

52
Q

What are examples of high dose inhaled corticosteroids (ICS) and LABA?

A

Relvar (fluticasone/vilanterol)

Fostair MDI

53
Q

What should be known about the cost of COPD treatment?

A

It is very expensive, from drug costs to support

54
Q

What does LTOT stand for?

A

Long term oxygen

55
Q

When can long term oxygen be used for COPD?

A

PaO2 < 7.2kPa

or PaCO2 7.3-8kPa if polycythaemia, nocturnal hypoxia, peripheral oedema or pulmonary hypertension)

56
Q

What symptoms would warrent using long term oxygen?

A

Polycythaemia

Nocturnal hypoxia

Peripheral oedema

Pulmonary hypertension

57
Q

What is polycythaemia?

A

Abnormally increased concentration of haemoglobin in the blood

58
Q

What is abnormally increased level of haemoglobin in the blood known as?

A

Polycythaemia

59
Q

What is the progression of clinical presentation of COPD?

A

At risk

Symptomatic

Exacerbations

Respiratory failure

60
Q

What happens during COPD exacerbations?

A

Increasing breathlessness

Cough

Sputum volume

Sputum purulence

Wheeze

Chest tightness

61
Q

What does AECOPD stand for?

A

Acute exacerbations of chronic obstructive pulmonary disease

62
Q

What does the management of acute exacerbations of chronic obstructive pulmonary disease involve?

A

Short acting bronchodilators

Steroids

Antibiotics

Consider hospital admission if unwell

63
Q

What short acting bronchodilators are used during exacerbations of COPD?

A

Salbutamol and/or ipratropium

Nebulisers if cannot use inhalers

64
Q

What steroids are used during exacerbations of COPD?

A

Prednisolone 40mg per day for 5-7 days

65
Q

What should occur during exacerbations of COPD for you to consider hospital admission?

A

Tachypneoa

Low oxygen saturation (<92%)

Hypotension

66
Q

What investigations could be done if a patient with AECOPD is admitted into hospital?

A

Full blood count

Biochemistry and glucose

Theophylline concentration

Arterial blood gas

Electrocardiograph

Chest X-ray

Blood cultures in febile patients

Sputum microscopy, culture and sensitivity

67
Q

What is involved in AECOPD ward based management?

A

Oxygen target saturation 88-92%

Nebulised bronchodilators

Corticosteroids

Antibiotics (oral vs IV)

Assess for evidence of repiratory failure

68
Q

What is oxygen saturation target for AECOPD ward management?

A

88-92%

69
Q

What is used to assess for evidence of respiratory failure?

A

Clinical

Arterial blood gas

70
Q

What does acute respiratory failure require?

A

Ventilation

2. Respiratory Medicine (Lectures) (50 decks)

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