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Respiratory System DO > Management of COPD > Flashcards

Management of COPD Flashcards

1
Q

What does COPD stand for

A

Chronic Obstructive Pulmonary Disease

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2
Q

What is COPD

A

A combination of airflow obstruction and hyperinflation that is progressive and not fully reversible

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3
Q

Name a cause of airflow obstruction

A

Chronic bronchitis which is not fully reversible

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4
Q

What is chronic bronchitis

A

It causes thick sticky mucus to block up the airways and inflammation and swelling to further narrow the airway

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5
Q

Name a cause of hyperinflation

A

Emphysema

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6
Q

What does emphysema cause

A

Air exchange to become difficult in damaged alveoli causing air to become trapped

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7
Q

Name the symptoms of COPD

A

Breathlessness

Cough and recurrent chest infection

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8
Q

Name a cause of COPD

A

Smoking

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9
Q

How can smoking lead to the development of COPD

A

Tobacco in cigarettes releases a reactive oxygen species (‘free radicals’)
This causes the inactivation of antiproteases leading to an increase in neutrophil elastase
Tissue damage occurs leading to emphysema

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10
Q

What other things can increase neutrophil elastase

A

Nicotine in tobacco
IL-8 and TNF from free radicals
Both cause the release of neutrophils causing an increase in neutrophil elastase

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11
Q

What can a cogenital α1AT deficiency cause to occur

A

Increase neutrophil elastase leading to tissue damage

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12
Q

What can an increase in macrophage elastase and metabolic proteinases lead to

A

Tissue damage

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13
Q

What are some other outcomes of COPD (non-respiratory)

A

Loss of muscle mass
Weight loss
Cardiac disease
Depression, anxiety etc.

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14
Q

What are the two main respiratory illnesses which COPD can cause

A

Emphysema

Chronic bronchitis

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15
Q

How many people in the UK are affected with COPD

A

1 million with a further 2 million undiagnosed

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16
Q

How many people in the UK die from COPD

A

30,000

By 2020 it will be the 3rd leading cause of death in the UK although it is largely preventable

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17
Q

How can COPD be diagnosis

A

Relevant history (symptoms)
Look for clinical signs
Confirmation of diagnosis and assessment of severity
Other relevant tests

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18
Q

What type of symptoms will cause the suspicion of COPD

A 
Patients aged 35 or more
Current or former smokers
Chronic cough
Exertional breathlessness
Sputum production
Frequent ‘winter’ bronchitis
Wheeze/chest tightness
19
Q

What are the differences between COPD and asthma

A

See table 3.5 in notes

20
Q

What features may be seen when examining for COPD

A 
Early stages may be normal
Reduced chest expansion
Prolonged expiration/wheeze
Hyperinflated chest
Respiratory failure
21
Q

What features may be seen upon examination for respiratory failure

A 
Tachypneoa
Cyanosis
Use of accessory muscles
Pursed lip breathing
Peripheral Oedema
22
Q

How can COPD be diagnosed

A

Through clinical history, examination and spirometry

23
Q

What will a clinical history show in COPD diagnosis

A

Cough
Breathlessness
Chest infections
Winter bronchitis

24
Q

What will an examination show in COPD diagnosis

A

May be normal
Tachypnoea
Wheeze
Hyperinflated chest

25
Q

What will a spirometry do in COPD diagnosis

A

It will confirm the diagnosis and assess the severity

26
Q

What does it mean if the FEV1 is over or equal to 80%

A

It is predicted to be mild

27
Q

What does it mean if the FEV1 is between 50-79%

A

It is predicted to be moderate

28
Q

What does it mean if the FEV1 is between 30-49%

A

It is predicted to be severe

29
Q

What does it mean if the FEV1 is under 30%

A

It is predicted to be very severe

30
Q

What are the baseline tests used for COPD

A

Spirometry which records absolute and % predicted values
Chest X-ray
ECG
Full blood count (query anaemic/polycythaemic/eosinophilia)
BMI (weight (kg)/height)
AIAT if the age of onset is under 50

31
Q

To prevent the onset of COPD what type of intervention should take place

A

Smoking cessation

32
Q

To relieve breathlessness caused by COPD what type of intervention should take place

A

Use of inhalers

33
Q

To prevent exacerbation from COPD what type of intervention should take place

A

Use of inhalers, vaccines, pulmonary rehabilitation (PR)

34
Q

To manage the complications of COPD what type of intervention should take place

A

Long term oxygen therapy

35
Q

What type of non-pharmacological managements can be provided

A 
Smoking cessation
Vaccinations (annual flu vaccine and pneumococcal vaccine)
Pulmonary rehabilitation
Nutritional assessment
Psychological support
36
Q

What are the benefits of pharmacological managements

A

Relieve of symptoms
Prevention of exacerbations
Improve the quality of life

37
Q

Name three types of inhaled therapies

A

Short acting bronchodilators
Long acting bronchodilators
High dose inhaled corticosteroids (ICS) and LABA

38
Q

Give examples of short acting bronchodilators

A

SABA (e.g. salbutamol)

SAMA (e.g. ipratropium)

39
Q

Give examples of long acting bronchodilators

A

LAMA (Long acting anti – muscarinic agents e.g. umeclidinium, tioptropium etc)
LABA (Long acting B2 agonist e.g. salmeterol)

40
Q

Give examples of High dose inhaled corticosteroids (ICS) and LABA

A

Relvar (Fluticasone/vilanterol)

Fostair MDI

41
Q

When is long term oxygen treatment (LTOT) given

A

When a persons PaO2 is below 7.3 kPa
If they have a PaO2 between 7.3-8 kPa and have: nocturnal hypoxia, peripheral oedema, pulmonary hypertension or polycythaemia

42
Q

Name some exacerbating factors of COPD

A 
Increasing breathlessness
Cough
Sputum cough
Sputum purulence
Wheeze
Chest tightness
43
Q

What 4 methods can be used to manage AECOPD

A

Short acting bronchodilators
Steroids
Antibiotics
Hospital admission if unwell

44
Q

What investigations should be done for AECOPD (8)

A

Full blood count
Biochemistry and glucose
Theophylline concentration (in patients using theophylline preparation)
Arterial blood gas (documenting the amount of oxygen given and by what delivery device)
Electrocardiograph
Chest X-ray
Blood cultures in febrile patients
Sputum microscopy, culture and sensitivity

Respiratory System DO (33 decks)

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