Management of COPD Flashcards
Define COPD
Disease characterised by airflow obstruction (bronchitis) and poorly reversible airflow limitation (hyperinflation, emphysema). Usually progressive and associated with a persistent inflammatory response of the lungs, resulting in poor gas exchange
What are the two components of COPD?
Airflow obstruction - chronic bronchitis
Hyperinflation and loss of elasticity of lungs - emphysema
What are the symptoms of COPD?
Breathlessness Half breaths Cough Sputum production Recurrent chest infections Irreversible breathlessness (not asthma) Weight loss (all energy for breathing) Loss of muscle mass Cardiac disease - hypoxia, cor pulmonale Depression/anxiety
What causes COPD?
Smoking Pollution Occupational exposure to dust etc a1-antitrypsin deficiency Age
What are the clinical signs of COPD?
Hyperinflated chest Leaning forward, undressing, half breaths Cyanosis if severe Pursed lip breathing Use of accessory muscles Thin with loss of muscle Tracheal tug Nasal flare Reduced chest expansion Prolonged expiration and wheeze Reduced heart sounds Decreased FEV1 to <70%/PEFR
What are some complications of COPD?
Cor pulmonale
Respiratory failure
How do we classify COPD severity according to FEV1 values?
FEV1 80% = mild
FEV1 50-79% = moderate
FEV1 30-49% = severe
FEV1 <30% = very severe
What investigations do we carry out for COPD?
Spirometry and lung function tests CXR - hyperinflated, reduced markings CT scans - bullae ECG and ECHO - cor pulmonale FBC BMI - low BMI has poor prognosis Arterial blood gases a1-antitrypsin deficiency test
How do you manage COPD?
Smoking cessation Inhalers for breathlessness Pneumococcal and influenza vaccinations Long term O2 therapy if needed Mucolytics Diuretics High calorie diet Bullectomy or lung volume reduction surgery Psychological support
What inhaled therapies are given to COPD patients?
Short acting bronchodilators e.g. salbutamol
Long acting bronchodilators (LAMA/LABA)
High dose inhaled corticosteroids
Describe what agents are used in pharmaceutical therapy at different stages of COPD
1st - SABA/SAMA alone
2nd - LABA/LAMA
3rd - Two LABA/LAMA agents
4th - triple therapy of ICS, LABA and LAMA
What is given in acute exacerbations of COPD?
Nebulised short acting bronchodilators Steroids Antibiotics Diuretics for oedema O2 ventilation therapy if needed (NIV)
What is the target O2 sats in COPD patients?
88-92%
How can COPD cause respiratory failure?
Type I - V/Q mismatch, caused by damaged lung tissue
Type II - alveolar hypoventilation caused by loss of alveolar SA and airway obstruction
