Management of COPD Flashcards
what is the aetiology of COPD?
environmental exposure to tobacco
Family clusters
AAT1 deficiency
what are characteristics in the definition of COPD?
- progressive
- airflow obstruction
- not fully reversible
- doesn’t change much over months
what conditions make up COPD?
chronic bronchitis
emphysema
airway obstruction
why is COPD related to smoking?
Smoking causes increase macrophages –> increase proteases –> destruction of collagen and elastase –> damage to the alveolour wall –> emphysema
- paralysis of cilia
- mucous gland hyperplasia and hypersecretion –> chronic bronchitis
what is seen in the pathology of chronic bronchitis?
increased goblet cells gland hypertrophy presence of mucous glands in smaller airways bronchial wall inflammation mucosal thickening
what can be used to measure the extent of emphysema?
CT scans can show the dead space
pulmonary function tests will show increased residual vol
spiromtry
why is there airway obstruction in emphysema?
There are less alveoli to hold the airway wall open causing bronchial collapse
what spirometry results indicate obstructive disease?
- decreased FEV1 often 70% or more below predicted
ratio <0.7
how can we measure if the changes seen in emphysema are reversible or not?
measure FEV1 pre and post bronchodilator. Able to reverse if there’s above a 15% improvement
what are clinical signs of COPD?
wheeze, hyperinflation, pursed lip breathing, central cyanosis, flapping tremor, cor pulmonale, weight loss.
how many pack years do you normally need to cause COPD?
20
what investigations are done in COPD?
lung function, chest x ray, sputum, FBC,ABG, ECG
what is involved in the long term management of COPD?
- vaccinations for influenza and pneumococcal
- inhalers: beta 2 agonist, anticholinergic, steroid
- theophyline
- diuretics
- LTOT
- mucolytics
what bronchodilators are used in COPD?
Beta 2 receptor agonists
anti muscarinic
what are the guidelines for on going breathlessness in COPD?
Start with a SABA/SAMA
if FEV1 is below 50% use a LABA and ICS or LAMA
if FEV1 is above half use just a LABA or a LAMA
what are causes of COPD exacerbations?
infections mainly viral
air pollution
smoking
how do you treat exacerbations in COPD?
broad spectrum antibiotics: penicillin, macrolide or tetracycline oral prednisolone nebulised bronchodilators physio low flow oxygen
why are exacerbations in COPD importantant?
increased mortality
increases decline in lung function
what can be done to prevent exacerbations in COPD?
- inhaled steroids
- vaccinations
- pulmonary rehab
- rescue pack antibiotics
what are the advantages of giving oxygen to patients with COPD
- increased 5 year survival
- less polycythaemia
- improved pulmonary hypertension
who do you give LTOT?
- partial oxygen below 7.3 on 2 occasions at least 3 weeks apart and clinically stable
- patient with partial oxygen between 7.3 and 8 but also have: PHT, polycythaemia, cor pumonale
