Respiratory Medicine 3 - COPD

Question 1

What is COPD?

What causes it?

How is it caused?

List some symptoms of COPD:

Answer 1

Chronic Obstructive Pulmonary Disease

• airway obsrtuction which is not fully reversible
• progressive over time
• caused by smoking, mostly, air pollution sometimes
• diagnosed by history, examination and spirometry

Forced expiratory volume in 1 second/forced vital capacity ratio <70% predicted

Symptoms:

• breathlessness: linked to exertion
• wheeze: consistent
• chronic cough and sputum production
• frequent infections (stagnant mucous)

Question 2

How is COPD managed?

Answer 2

• smoking cessation - slow pace of progression
• pulmonary rehabilitation - help with living woth COPD
• vaccination - reduce chance of flu or pneumococcal infection

Question 3

List some differences between COPD and asthma:

Answer 3

COPD: nearly all smokers, rarely symptoms under age 35, common chronic productive cough, persistent and progressive breathlessness, uncommon for night time waking/diurnal day to day interruptions

Asthma: possible in smokers and non-smokers, often symptoms under 35, uncommon productive cough, variable breathlessness, common night-time waking

Question 4

Explain COPD inhaled meds management:

Answer 4

1. Short acting beta agonist
2. Add long acting muscarinic agonist ir long acting beta agonist
3. Add bith LAMA and LABA
4. Add LAMA and LABA and inhaled corticosteroid (trelegy)

Consider:

• mucolytics - thin mucous secretions
• home oxygen - safety oxygen
• prophylactic antibiotics

Question 5

List the main groups of treatments used:

Answer 5

SABA - salbutamol or terbutaline

LABA - formoterol, salmeterol, vilanterol

LAMA - tiotropium, glycopyrronium, aclidinium

ICS - beclomethasone, fluticasone

Combination products:

• anoro ellipta - LAMA and LABA
• relvar ellipta - LABA and ICS
• Trelegy - LAMA, LABA and ICS

Question 6

How to manage acute exacerbation of COPD:

Answer 6

• ABCDE approach
• Sit patient up
• Salbutamol: 2 puffs via spacer or nebulised 5mg
• Cautious oxygen delivery to maintain stats 88-92%
• Consider patient referral to GP or hospital

Question 7

What are some dental aspects of COPD?

Answer 7

• same as for asthma - re: inhaled therapy side effects
• very breathless patients may find lying flat unpleasant and prefer to be more upright for treatment