Management of COPD Flashcards
What does COPD stand for
Chronic Obstructive Pulmonary Disease
What is COPD
A combination of airflow obstruction and hyperinflation that is progressive and not fully reversible
Name a cause of airflow obstruction
Chronic bronchitis which is not fully reversible
What is chronic bronchitis
It causes thick sticky mucus to block up the airways and inflammation and swelling to further narrow the airway
Name a cause of hyperinflation
Emphysema
What does emphysema cause
Air exchange to become difficult in damaged alveoli causing air to become trapped
Name the symptoms of COPD
Breathlessness
Cough and recurrent chest infection
Name a cause of COPD
Smoking
How can smoking lead to the development of COPD
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
What other things can increase neutrophil elastase
Nicotine in tobacco
IL-8 and TNF from free radicals
Both cause the release of neutrophils causing an increase in neutrophil elastase
What can a cogenital α1AT deficiency cause to occur
Increase neutrophil elastase leading to tissue damage
What can an increase in macrophage elastase and metabolic proteinases lead to
Tissue damage
What are some other outcomes of COPD (non-respiratory)
Loss of muscle mass
Weight loss
Cardiac disease
Depression, anxiety etc.
What are the two main respiratory illnesses which COPD can cause
Emphysema
Chronic bronchitis
How many people in the UK are affected with COPD
1 million with a further 2 million undiagnosed
How many people in the UK die from COPD
30,000
By 2020 it will be the 3rd leading cause of death in the UK although it is largely preventable
How can COPD be diagnosis
Relevant history (symptoms)
Look for clinical signs
Confirmation of diagnosis and assessment of severity
Other relevant tests
What type of symptoms will cause the suspicion of COPD
Patients aged 35 or more Current or former smokers Chronic cough Exertional breathlessness Sputum production Frequent ‘winter’ bronchitis Wheeze/chest tightness
What are the differences between COPD and asthma
See table 3.5 in notes
What features may be seen when examining for COPD
Early stages may be normal Reduced chest expansion Prolonged expiration/wheeze Hyperinflated chest Respiratory failure
What features may be seen upon examination for respiratory failure
Tachypneoa Cyanosis Use of accessory muscles Pursed lip breathing Peripheral Oedema
How can COPD be diagnosed
Through clinical history, examination and spirometry
What will a clinical history show in COPD diagnosis
Cough
Breathlessness
Chest infections
Winter bronchitis
What will an examination show in COPD diagnosis
May be normal
Tachypnoea
Wheeze
Hyperinflated chest
What will a spirometry do in COPD diagnosis
It will confirm the diagnosis and assess the severity
What does it mean if the FEV1 is over or equal to 80%
It is predicted to be mild
What does it mean if the FEV1 is between 50-79%
It is predicted to be moderate
What does it mean if the FEV1 is between 30-49%
It is predicted to be severe
What does it mean if the FEV1 is under 30%
It is predicted to be very severe
What are the baseline tests used for COPD
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
To prevent the onset of COPD what type of intervention should take place
Smoking cessation
To relieve breathlessness caused by COPD what type of intervention should take place
Use of inhalers
To prevent exacerbation from COPD what type of intervention should take place
Use of inhalers, vaccines, pulmonary rehabilitation (PR)
To manage the complications of COPD what type of intervention should take place
Long term oxygen therapy
What type of non-pharmacological managements can be provided
Smoking cessation Vaccinations (annual flu vaccine and pneumococcal vaccine) Pulmonary rehabilitation Nutritional assessment Psychological support
What are the benefits of pharmacological managements
Relieve of symptoms
Prevention of exacerbations
Improve the quality of life
Name three types of inhaled therapies
Short acting bronchodilators
Long acting bronchodilators
High dose inhaled corticosteroids (ICS) and LABA
Give examples of short acting bronchodilators
SABA (e.g. salbutamol)
SAMA (e.g. ipratropium)
Give examples of long acting bronchodilators
LAMA (Long acting anti – muscarinic agents e.g. umeclidinium, tioptropium etc)
LABA (Long acting B2 agonist e.g. salmeterol)
Give examples of High dose inhaled corticosteroids (ICS) and LABA
Relvar (Fluticasone/vilanterol)
Fostair MDI
When is long term oxygen treatment (LTOT) given
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
Name some exacerbating factors of COPD
Increasing breathlessness Cough Sputum cough Sputum purulence Wheeze Chest tightness
What 4 methods can be used to manage AECOPD
Short acting bronchodilators
Steroids
Antibiotics
Hospital admission if unwell
What investigations should be done for AECOPD (8)
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
