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Conditions: Respiratory > Management of COPD > Flashcards

Management of COPD Flashcards

1
Q

What causes airway obstruction in COPD?

A

Small airway narrowing

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2
Q

What endogenous substances and responses can make small airway narrowing worse?

A

Mucous and inflammation

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3
Q

What does worsening of airway narrowing resulting in?

A
  • Breathlessness on less exertion - Coughing- Wheeze
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4
Q

What is the gender predominance of COPD?

A
  • Male more than female
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5
Q

What is the relationship between income and COPD?

A

Lower income households have a higher prevalence

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6
Q

How does COPD impact NHS?

A
  • Increasing prevalence - GP hours - Hospital beds
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7
Q

What percentage of total COPD cases are linked to smoking?

A

85%

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8
Q

How does maternal smoking contribute to COPD?

A
  • Reduces FEV1- Increases chances of IRDS
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9
Q

What occupations are associated with COPD?

A
  • Mining - Tunnel working - Construction - Farming - Any occupation involving exposure to dust
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10
Q

What is the function of a1 antitrypsin?

A

Neutralise enzymes released by neutrophils

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11
Q

What is the normal genotype for functioning a1 antitrypsin?

A

FiMM

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12
Q

What is the abnormal genotype for a1 antitrypsin?

A

PiZZ

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13
Q

How many years do you have to smoke a pack a day to typically have smoking related COPD?

A

20 years

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14
Q

What conditions are involved in the differential diagnosis of COPD?

A
  • Asthma - Lung cancer - Left ventricular failure - Fibrosing alveolitis - Bronchiectasis - TB- PE
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15
Q

How should a diagnosis of COPD be done?

A
  • Eliminate all other possible diagnoses first
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16
Q

What symptom differs asthma from COPD?

A
  • Asthma is a variable obstruction
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17
Q

What systemic symptoms may a patient with COPD present with?

A
  • Cachexia - Peripheral Oedema
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18
Q

What other conditions should be considered if haemoptysis occurs?

A
  • Lung cancer- TB- Bronchiectasis
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19
Q

What does peripheral oedema suggest?

A
  • Cor pulmonale- Severe disease- Resp failure
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20
Q

With an adult with COPD, what might show in their childhood medical history?

A

Childhood asthma

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21
Q

What heart condition commonly shows in the PMH of a person with COPD?

A

Ischaemic heart disease

22
Q

What is important when taking a drug history of someone with suspected COPD?

A
  • Any inhalers - Previous medications which may effect breathing
23
Q

What are the clinical SIGNS of typical COPD?

A
  • Breathlessness- Pursed lip breathing - Accessory breathing - Cyanosis - Flapping tremor
24
Q

Investigations needed before COPD diagnosis?

A
  • Spirometry - Full pulmonary function test- Lung volumes - CO gas transfer- Reversibility of obstruction from bronchodilators and oral corticosteroids
25
Q

After initial investigations rule out asthma, what other investigations could be done?

A
  • Chest x ray- Blood gases - FBC- ECG- Sputum
26
Q

If FEV1 is normal what does it indicate with regards to COPD?

A

It rules it out

27
Q

What spirometry results would indicate COPD?

A

FEV1/FVC ratio less than 70%

28
Q

What chronic obstructive condition are you looking for when doing a pulmonary full functionality test?

A

Emphysema

29
Q

What can be seen from doing spirometry?

A

Fixed airflow obstruction

30
Q

What should happen to a patient with COPD in response to bronchodilators?

A

Minimal to no help

31
Q

What should happen to a patient with COPD in response to oral corticosteroids?

A

Minimal to no help

32
Q

If a suspected COPD sufferer responds to bronchodilators/oral corticosteroids what is probably going to be the diagnosis?

A

Asthma

33
Q

What may be seen on a chest X ray of a COPD sufferer?

A
  • Hyperinflated lungs- Flattened diaphragm- Bulla
34
Q

What do chest x rays help diagnose if it isn’t COPD?

A
  • Cancer - Interstitial disease- Left ventricle failure
35
Q

What does a decreased PaO2 and normal PaCO2 indicate?

A

Type 1 respiratory failure

36
Q

What does a decreased PaO2 and increased PaCO2 indicate?

A

Type 2 respiratory failure

37
Q

What is the condition called that means a high level of RBC’s and will be shown by a FBC?

A

Polycytheamia

38
Q

What might be found on a sputum test (MC&S)?

A
  • Streptococcus pneumoniae- Haemophilus Influenzae- Moraxella Catarrhalis
39
Q

What CONDITIONS can cause an acute exacerbation of COPD symptoms?

A
  • Viral/bacterial infection - Pneumothorax - Trauma
40
Q

How should acute exacerbations of COPD be managed?

A
  • B2 bronchodilators - O2 - Oral corticosteroids - Antibiotics - Diuretics - Resp. stimulant
41
Q

What is smoking cessation?

A

Quitting smoking

42
Q

What is the aim of smoking cessation?

A

Prevention of progression of disease

43
Q

What NHS management methods are there for COPD?

A
  • Inhalers - Vaccines - Rehabilitation - Long term oxygen therapy
44
Q

What lifestyle management methods are available?

A
  • Smoking cessation - Nutritional changes
45
Q

What inhaled therapy options are there to relieve symptoms?

A
  • Short and long acting bronchodilators - High dose corticosteroids
46
Q

2 examples of short acting bronchodilators?

A
  • Salbutamol- Ipratropium
47
Q

2 examples of long acting bronchodilators

A
  • Umeclidinium (long acting anti-muscarinic agent)- Salmeterol (long acting B2 agonist)
48
Q

2 examples of high dose inhaled corticosteroids?

A
  • Relvar - Fostair MDI
49
Q

When is long term oxygen used?

A
  • PaO2 <7.3kPa- Normal PaO2 but with polycythaemia, sleep apnea, peripheral oedema or pulmonary hypertension
50
Q

When should hospital admission of AECOPD be considered?

A
  • Tachypnoea - Low sats- Hypotension
51
Q

What steroid treatment is standard for AECOPD?

A

Prednisolone 40mg per day for a week

52
Q

How should AECOPD patients on the ward be monitored?

A
  • Try get sats to 92%- Nebulised bronchodilators - Corticosteroids - Antibiotics

Conditions: Respiratory (16 decks)

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