Problem 1: Suboptimal COPD management Flashcards
How is COPD diagnosed?
Characterised by airflow limitation that is NOT fully reversible. Spirometry tests are needed to confirm diagnosis once clinical signs/symptoms have been considered. Chest x-ray and blood tests needed to rule out differential diagnosis.
What are the key differences in the signs and symptoms of asthma v COPD?
Breathlessness in asthma is transient / exercise induced, chronic breathlessness is COPD. Smoking / 35 years and over COPD, younger patients asthma. Chronic productive cough is key sign of COPD. Night time wheezing asthma. Varying symptoms day to day more common in asthmatic patients.
What is the NICE guidance for COPD 2010? Treatment table
Draw - FEV1 < 50% and > 50%.
What are the subtypes of COPD?
Emphysema (pink puffers)
- good respiratory drive, severe onset of dyspnoea, breathless and pursed lip breathing. Thin, well perfused so pink in colouration.
Chronic bronchitis (blue bloaters)
- minimal breathlessness but respiratory failure (hypoxia and hypercapnia). Overweight, central cyanosis (blue tinge), productive cough, increased purulent sputum.
Polycythemia and Cor Pulmonale are complication associated with chronic bronchitis.
How are the subtypes of COPD managed pharmacologically?
Mucus production in blue bloaters with acetylcysteine or carbocysteine.
What is spirometry?
Tests lung function; measures the volume of air that can be expelled from a patients lungs (in one second FEV1) and FVC.
What is FEV1 and FVC?
Forced expiratory volume in 1 sec
Forced volume capacity
How are spirometry test results obtained? Why are they useful?
Obtained from a spirometry machine available in most GP surgeries / hospitals. Handheld device that takes measurements of factors such as FVC and FEV1. Results can be compared to predicted results for age group / patient profile which allows from comparison. Percentages of predicted outcomes and ratios between FVC and FEV1 allow for analysis of a patients lung function.
How to calculate FEV1:FVC and interpret results?
FEV1:FVC ratio; interpretation of the results allows for indicators of COPD if ratio is reduced. Also allows to grade the severity of COPD.
How can FEV1 be predicted as a percentage and what does this show?
FEV1 predicted values can be found online / BNF p 214
What advice is normally given to patients about inhaler technique for Clenil and salbutamol?
See PiL
https: //www.medicines.org.uk/emc/medicine/3860
https: //www.medicines.org.uk/emc/product/6975
What are common problems encountered by patients using these inhalers?
Poor inadequate inhaler use technique, oral candiasis as a result of ICS, dry mouth if anti-muscarinic. Poor adherence
What are the options if inhaler technique does not prove effective?
Spacer, aerochamber
What evidence based benefits of quitting smoking can you provide to a patient?
Cardiovascular: coronary heart disease, angina, stroke, heart attack
Cancers: oesophageal/lung but also elsewhere in the body
Respiratory: lung function, COPD and lung cancer
What effect would smoking cessation impact on the breathing and glaucoma?
Slow down progression of COPD, help lungs to function at maximum capacity for as long as possible.
General blood capillaries in the body / cardiovascular health will be improved by smoking cessation. Nicotine vasoconstrictor, smoke damage to eyes, maccular degenration / cataracts also related to smoking.
