Management of COPD Flashcards
Which form of COPD is Airflow obstruction Hyperinflation?
Chronic Bronchitis Emphysema
Is COPD reversible?
Not fully It is also preogressive
What are the symptoms of COPD?
Breathlessness Cough Recurrent Chest infection (frequent ‘winter bronchitis) Sputum productions Wheeze/Chest tightness Usually in people aged 35 and older
Why do people develop COPD?
Reactive oxygen species Cause tissue damage and deactivate antiproteases (increase in neutrophil elastase) more tissue damage
What are the other health effects of COPD?
Loss of muscle mass - TNF interleukin affected - less drive to eat food Exercise ability is very poor Weight Loss Cardiac disease Depression, anxiety etc
What is the 3rd leading cause of death in the world?
COPD
How do you diagnose COPD?
- Relevant History (Symptoms) • Look for clinical signs • Confirmation of diagnosis and assessment of severity • Other relevant tests
What are the clinical differences between COPD and ASTHMA? Use the headings: Age, Cough, Smoking, breathlessness, nocturnal symptoms, family history, concomitant eczema or allergic rhinitis
What are the examinations for COPD?
No diagnostic tests
May be normal in early stages
Reduced chest expansion
Prolonged expiration/Wheeze
Hyperinflated chest
Respiratory failure
What are the different ways you can witness respiratory failure?
• Tachypneoa
- Cyanosis
- Use of accessory muscles
- Pursed lip breathing
- Peripheral Oedema
Ankle swelling too, because lots of strain on the right side of the heart
What is the use of spirometry in COPD?
COnfirms diagnosis and assesses severity
How do you analyse the results of a spiromtry to confirm COPD?
How do you assess the severity of COPD usinf FEV1/FVC?
What are the COPD baseline tests?
Anaemia can present itslef as breathlessness
HIgh blood cell count can be a sign of COPD
Polycthaemic means lots of RBC’s
AIAT is antitrypsin
LOOK
What are the ways you can manage COPD?
Prevention of disease progression
Releive breathlessness
Prevention of exacerbation
Management of complications
What is the interventions for the following aims?
Prevention of disease progression
Releive breathlessness
Prevention of exacerbation
Management of complications
Prevention of disease progression - Smoking cessation
Releive breathlessness - Inhalers
Prevention of exacerbation - Inhalers, Vasccines, Pulmonary Rehabilitation
Management of complications - Long term Oxygen therapy
What vaccines can help prevent exacerbation?
– Annual Flu vaccine
– Pneumococcal vaccine
What is the non-pharmacological management of COPD?
What does pulmonary rehabilitation involve?
What are the benefits of Pulmonary Rehabilitation?
What are the benefits of Pharmacological Management?
– Relieve symptoms
– Prevent exacerbations
– Improve quality of life
What are the short acting bronchodilators used for inhaled therapy in COPD?
What are the long acting bronchodilators used to treat COPD?
– Relieve symptoms
– Prevent exacerbations – Improve quality of life
What are examples of High dose inhaled corticosteroids (ICS and LABA)
How does the COPD inhaler treatment progress with severity, symptoms and exacerbation?
What is QALY?
A measurement used to measure one year of good quality life
What are the most expensive treatment methods for COPD per QALY?
Who benefits from long term oxygen therapy?
People who are hypoxic to the point of
LOOK
What are the symptoms of COPD exacerbation?
What is the effect of AECOPD on alveoli and mucus glands (including goblet cells)?
Alveolar wall destruction and mucus hypersecretion
What does management of AECOPD involve?
Short acting bronchodilators (salbutamol/ipratropium/nebulisers)
Steroids (Prednisolone 40mg per day for 5-7 days)
Antibiotics (only if there is evidence of infection: Fever, increase in volume/purulence of sputum)
Hospital admission if unwell (tachypnea, low oxygen saturation (below 90-92 %)Hypotension.
What are the relevant AECOPD investigations?
Full blood count
Biochemistry of glucose
Theophyline concentration (in patients using theophyline concentration)
Arterial blood gas
Electrocardiograph
Chest X-Ray
Blood cultures in febrile patients
Sputum Microscopy, culture and sensitivity
