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S2 Respiratory System > Management of COPD > Flashcards

Management of COPD Flashcards

1
Q

what is COPD called when related to airflow obstruction?

A

chronic bronchitis

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2
Q

how reversible is chronic bronchitis?

A

not fully reversible

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3
Q

what is COPD called when related to hyperinflation of terminal bronchiole/alveoli?

A

emphysema

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4
Q

what is the effect of having lots of neutrophils and elastase?

A

tissue damage

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5
Q

what does an increased number of alveolar macrophage do?

A

increased alveolar macrophage, elastase and metallo-proteinases provoke tissue damage

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6
Q

what causes tissue damage in COPD?

A

increased neutrophil and elastase in the blood, increased alveolar macrophage, elastase and metallo-proteinases in the alveoli

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7
Q

what causes increase in elastase?

A

congenital alpha-1-AT deficiency and ‘functional’ alpha-1-AT deficiency

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8
Q

what causes ‘functional’ alpha-1-AT deficiency?

A

inactivation of antiproteases caused by reactive oxygen species (‘free radicals’)

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9
Q

what causes increase in neutrophils?

A

nicotine and IL-B, LT4 and TNF

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10
Q

what releases nicotine and reactive oxygen species?

A

tobacco

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11
Q

what are the main respiratory symptoms for COPD?

A

chronic cough, exertional breathlessness, sputum production, frequent “winter” bronchitis, wheeze, chest tightness and recurrent chest infection

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12
Q

what none-respiratory symptoms does COPD cause?

A

loss of muscle mass, weight loss, cardiac disease, depression, anxiety etc

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13
Q

patient bio- when to suspect COPD?

A

aged 35 or more, current or former smokers

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14
Q

what are the clinical differences between COPD and asthma in terms of age difference?

A

COPD: >35 years
asthma: any age

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15
Q

what are the clinical differences between COPD and asthma in terms of cough?

A

COPD: persistent and productive
asthma: intermittent and non-productive

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16
Q

what are the clinical differences between COPD and asthma in terms of smoking history?

A

COPD: invariably always one
asthma: possible

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17
Q

what are the clinical differences between COPD and asthma in terms of breathlessness?

A

COPD: progressive and persistent
asthma: intermittent and variable

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18
Q

what are the clinical differences between COPD and asthma in terms of nocturnal symptoms?

A

COPD: uncommon unless in severe disease
asthma: common

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19
Q

what are the clinical differences between COPD and asthma in terms of family history?

A

COPD: uncommon unless family members also smoke
asthma: common

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20
Q

what are the clinical differences between COPD and asthma in terms of presence of concomitant eczema or allergic rhinitis?

A

COPD: possible
asthma: common

21
Q

what should the clinician observe when looking for COPD?

A

normality in normal stages, reduced chest expansion, prolonged expiration/ wheeze, hyper inflated chest, respiratory failure (tachypnoea, cyanosis, use of accessory muscles, pursed lip breathing, peripheral oedema)

22
Q

what is tachypnoea?

A

abnormally fast breathing

23
Q

what is cyanosis?

A

bluish discolouration of skin/ mucous membranes due to excessive concentration of desoxyHb

24
Q

what test enables confirmation of diagnosis and assessment of severity?

A

spirometry

25
what respiratory disorder is present if FEV1/FVC < 70%?
obstructive
26
what respiratory disorder is present if FEV1/FVC > 70%?
none or restrictive
27
what respiratory disorder is present if FEV1/FVC < 70% and FEV1 > 80%?
no disorders
28
what respiratory disorder is present if FEV1/FVC < 70% and FEV1 < 80%?
restrictive, the lower the FEV1 the more severe
29
what other baseline tests are there for COPD?
chest X-ray, ECG, full bloom count, BMI, A1AT test?
30
how do you relieve breathlessness?
inhalers
31
how do you prevent exacerbation?
inhalers, vaccines, pulmonary rehabilitation (PR)
32
how do you manage complications of COPD?
long term oxygen therapy
33
how do you prevent disease progression?
smoking cessation
34
how to manage COPD without pharmacological involvement?
pulmonary rehabilitation
35
name two short acting bronchodilators
SABA (salbutamol), SAMA (ipratropium)
36
name two long acting bronchodilators
LAMA (long acting anti-muscarinic agents (umeclidinium, tioptropium), LABA (long acting B2 agonist (salmeterol))
37
high dose inhaled corticosteroids (ICS) and LABA
relvar (fluticasone/ vilanaerol), fostair MDI
38
which inhaler treatment is the first line of treatment for COPD?
SABA
39
when would you use LAMA or LABA?
as 2nd line of treatment
40
when would you use LAMA and LABA?
as 3rd line of treatment
41
when would you use triple therapy? (ICS, LABA and LAMA)
as last resort (if FEV1 decreases and symptoms & exacerbations increase)
42
under which conditions would a patient need long term oxygen (LTOT)?
PaO2 < 7,3 kPa or PaO2 7,3-8kPa if polycythaemia, nocturnal hypoxia, peripheral oedema, pulmonary hypertension
43
what is exacerbation?
sudden worsening of symptoms due to infection or environment. Causes increasing breathlessness, cough, sputum volume and purulence increase, wheeze, chest tightness (neutrophil increase releases elastase)
44
which steroid and in which quantity should be prescribed if Acute Exacerbating factors in COPD (AECOPD) appear?
prednisolone 40 mg per day for 5-7 days
45
under which conditions in AECOPD should antibiotics be prescribed?
if there is evidence of infection (fever, increase in volume/ purulence of sputum)
46
when should hospital admission be considered in AECOPD?
tachypneoa, low O2 saturation (<90-92%), hypotension etc
47
how do you manage AECOPD on the wards?
oxygen with 88-92% saturation, nebuliser bronchodilatators, corticosteroids, antibiotics (oral vs IV), assess for evidence of respiratory failure (clinical/ arterial blood gas (ABG))
48
which investigations would you conduct for a patient recently admitted in hospital for AECOPD?
full blood count, biochemistry and glucose, theophylline concentration, arterial blood gas, ECG, CXR, blood culture for febrile patients, sputum microscopy, culture and sensitivity

S2 Respiratory System (43 decks)

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