Management of COPD Flashcards
what is COPD called when related to airflow obstruction?
chronic bronchitis
how reversible is chronic bronchitis?
not fully reversible
what is COPD called when related to hyperinflation of terminal bronchiole/alveoli?
emphysema
what is the effect of having lots of neutrophils and elastase?
tissue damage
what does an increased number of alveolar macrophage do?
increased alveolar macrophage, elastase and metallo-proteinases provoke tissue damage
what causes tissue damage in COPD?
increased neutrophil and elastase in the blood, increased alveolar macrophage, elastase and metallo-proteinases in the alveoli
what causes increase in elastase?
congenital alpha-1-AT deficiency and ‘functional’ alpha-1-AT deficiency
what causes ‘functional’ alpha-1-AT deficiency?
inactivation of antiproteases caused by reactive oxygen species (‘free radicals’)
what causes increase in neutrophils?
nicotine and IL-B, LT4 and TNF
what releases nicotine and reactive oxygen species?
tobacco
what are the main respiratory symptoms for COPD?
chronic cough, exertional breathlessness, sputum production, frequent “winter” bronchitis, wheeze, chest tightness and recurrent chest infection
what none-respiratory symptoms does COPD cause?
loss of muscle mass, weight loss, cardiac disease, depression, anxiety etc
patient bio- when to suspect COPD?
aged 35 or more, current or former smokers
what are the clinical differences between COPD and asthma in terms of age difference?
COPD: >35 years
asthma: any age
what are the clinical differences between COPD and asthma in terms of cough?
COPD: persistent and productive
asthma: intermittent and non-productive
what are the clinical differences between COPD and asthma in terms of smoking history?
COPD: invariably always one
asthma: possible
what are the clinical differences between COPD and asthma in terms of breathlessness?
COPD: progressive and persistent
asthma: intermittent and variable
what are the clinical differences between COPD and asthma in terms of nocturnal symptoms?
COPD: uncommon unless in severe disease
asthma: common
what are the clinical differences between COPD and asthma in terms of family history?
COPD: uncommon unless family members also smoke
asthma: common
what are the clinical differences between COPD and asthma in terms of presence of concomitant eczema or allergic rhinitis?
COPD: possible
asthma: common
what should the clinician observe when looking for COPD?
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)
what is tachypnoea?
abnormally fast breathing
what is cyanosis?
bluish discolouration of skin/ mucous membranes due to excessive concentration of desoxyHb
what test enables confirmation of diagnosis and assessment of severity?
spirometry
what respiratory disorder is present if FEV1/FVC < 70%?
obstructive
what respiratory disorder is present if FEV1/FVC > 70%?
none or restrictive
what respiratory disorder is present if FEV1/FVC < 70% and FEV1 > 80%?
no disorders
what respiratory disorder is present if FEV1/FVC < 70% and FEV1 < 80%?
restrictive, the lower the FEV1 the more severe
what other baseline tests are there for COPD?
chest X-ray, ECG, full bloom count, BMI, A1AT test?
how do you relieve breathlessness?
inhalers
how do you prevent exacerbation?
inhalers, vaccines, pulmonary rehabilitation (PR)
how do you manage complications of COPD?
long term oxygen therapy
how do you prevent disease progression?
smoking cessation
how to manage COPD without pharmacological involvement?
pulmonary rehabilitation
name two short acting bronchodilators
SABA (salbutamol), SAMA (ipratropium)
name two long acting bronchodilators
LAMA (long acting anti-muscarinic agents (umeclidinium, tioptropium), LABA (long acting B2 agonist (salmeterol))
high dose inhaled corticosteroids (ICS) and LABA
relvar (fluticasone/ vilanaerol), fostair MDI
which inhaler treatment is the first line of treatment for COPD?
SABA
when would you use LAMA or LABA?
as 2nd line of treatment
when would you use LAMA and LABA?
as 3rd line of treatment
when would you use triple therapy? (ICS, LABA and LAMA)
as last resort (if FEV1 decreases and symptoms & exacerbations increase)
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
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)
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
under which conditions in AECOPD should antibiotics be prescribed?
if there is evidence of infection (fever, increase in volume/ purulence of sputum)
when should hospital admission be considered in AECOPD?
tachypneoa, low O2 saturation (<90-92%), hypotension etc
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))
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
