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Semester 2 > Management of COPD COPY > Flashcards

Management of COPD COPY Flashcards

1
Q

How can COPD be ‘defined’?

A
  • Airflow obstruction
  • Progressive
  • Not fully reversible
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2
Q

What symptoms are there in COPD?

A
  • Breathlessness
  • Cough
  • Recurrent chest infection
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3
Q

Why do people develop COPD?

A
  • Smoking causes inactivation of antiproteases or a1 AT deficiency
  • Both lead to increase in neutrophils and elastase
  • Tissue damage
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4
Q

People with COPD often have other conditions such as…

A
  • Loss of muscle mass
  • Weight loss
  • Cardiac disease
  • Depression, anxiety etc
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5
Q

What is required to diagnose COPD?

A
  • Relevant history
  • Look for clinical signs
  • Confirmation of diagnosis and assessment of severity
  • Other relevant tests
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6
Q

What history would suggest COPD?

A
  • Aged 35 or over
  • Current or former smoker
  • Chronic cough
  • Exertional breathlessness
  • Sputum production
  • frequent Winter Bronchitis
  • Wheeze or chest tightness
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7
Q

What might be seen on examination of a COPD patient?

A
  • Reduced chest expansion
  • Prolonged expiration/wheeze
  • Hyperinflated chest
  • Respiratory failure
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8
Q

What are signs of respiratory failure?

A
  • Tachypneoa
  • Cyanosis
  • Use of accessory muscles
  • Pursed lip breathing
  • Peripheral oedema
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9
Q

What investigation can be used to confirm COPD and assess the severity?

A

Spirometry

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10
Q

What baseline tests should be performed?

A
  • Spirometry
  • Chest X-ray
  • ECG
  • Full blood count
  • BMI
  • AIAT if under 50 years old
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11
Q

What is the aim of smoking cessation?

A

Prevention of disease progression

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12
Q

What is the aim of inhalers?

A

Relieve breathlessness

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13
Q

What is the aim of inhalers, vaccines and pulmonary rehabilitation?

A

Prevention of exacerbation

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14
Q

What is the aim of long term oxygen therapy?

A

Management of complications

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15
Q

What non-pharmacological options for management are there?

A
  • Smoking cessation
  • Vaccinations
  • Pulmonary rehabilitation
  • Nutritional assessment
  • Psychological support
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16
Q

What are the benefits of pharmacological management?

A
  • Relieve symptoms
  • Prevent exacerbations
  • Improve quality of life
17
Q

What inhaled therapy options are there?

A
  • Short acting bronchodilators
  • Long acting bronchodilators
  • High dose corticosteroids
18
Q

What are examples of short acting bronchodilators?

A
  • SABA: salbutamol

- SAMA: ipratropium

19
Q

What are examples of long acting bronchodilators?

A
  • LAMA: long acting anti-muscarinic agents: umeclidinium, tioptropium
  • -LABA: long acting B2 agonist: salmeterol
20
Q

What are examples of high dose inhaled corticosteroids?

A
  • Relvar (fluticasone/vilanterol)

- Fostair MDI

21
Q

How does treatment change with worsening FEV1?

A
  • SABA
  • LAMA or LABA
  • LAMA and LABA
  • ICS, LABA and LAMA
22
Q

When is long term oxygen (LTOT) used?

A 
-When PaO2<7.3kPa
OR
-When PaO2 7.3-8kPa but with 
  -Polycythaemia
  -Nocturnal hypoxia
  -Peripheral oedema
  -Pulmonary hypertension
23
Q

What are symptoms of AECOPD?

A

-Increasing breathlessness
-Cough
-Sputum volume
-Sputum purulence
-Wheeze
Chest tightness

24
Q

How should AECOPD be managed?

A
  • Short acting bronchodilators
  • Steroids
  • Antibiotics if evidence of infection
  • Consider hospital admission
25
Q

When should hospital admission be considered in cases of AECOPD?

A
  • Tachypneoa
  • Low oxygen saturation <90%
  • Hypotension
26
Q

What steroid treatment should be given to patients with AECOPD?

A

Prednisolone 40mg per day for 5-7 days

27
Q

What investigations are required if patients are admitted with AECOPD?

A
  • FBC
  • Biochemistry and glucose
  • Theophylline concentration
  • Arterial blood gas
  • Echocardiograph
  • CXR
  • Blood cultures in febrile patients
  • Sputum microscopy, culture and sensitivity
28
Q

How should AECOPD patients on wards be managed?

A
  • Oxygen target saturation 88-92%
  • Nebulised bronchodilators
  • Corticosteroids
  • Antibiotics
  • Assessment for respiratory failure

Semester 2 (150 decks)

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