S-CA prep Flashcards
When to suspect COPD?
People aged >35 with risk factor (smoking, occupational or environmental exposure) + One or more of: breathlessness- persistent, progressive and worse on exertions, chronic cough, regular sputum, frequent lower resp infections and wheeze.
What spirometry findings confirm persistent airway obstruction?
Post bronchodilator FEV1/FVC less than 0.7 but consider other causes than COPD in older people with atypical features.
What is alpha-1 antitrypsin deficiency
A genetic disorder of recessive inheritance whereby the person does not produce alpha one antitripsin and therefore protease enzymes cause damage to lung tissue. It can also cause liver disease.
What is cor pulmonale?
Right heart failure secondary to lung disease. It is caused by pulmonary hypertension secondary to hypoxia. Suspect it in people with peripheral oedema, raised JVP, hepatomegaly.
What are the stages of the MRC dyspnoea scale
1 Not troubled by breathlessness except during strenuous exercise
2 Short of breath when hurrying or walking up a slight hill
3 Walks slower than contemporaries on the level because of breathlessness, or has to stop for breath when walking at own pace
4 Stops for breath after walking about 100 m or after a few minutes on the level
5 Too breathless to leave the house, or breathless when dressing or undressing
What is in the differential for COPD?
asthma, bronchiectasis, heart failure, lung cancer, interstitial lung disease, anaemia, TB, cystic fibrosis.
What to consider in management of stable COPD?
- Referral to respiratory specialist.
- Pulmonary rehab
- Oxygen therapy
- Physio/OT/dietician/ psychologist
- Stopping smoking
- Diet and physical activity advice
- Pneumococcal and influenza vaccinations
How do you assess the severity of COPD?
Objective- FEV 1 as a percentage of predicted.
≥80% Mild/stage 1
50–79% Moderate/stage 2
30–49% Severe/stage 3
<30% Very severe/stage 4
Subjective- MRC dyspnoea score
What advice should be given for rescue packs in COPD?
Home rescue therapy reduces admissions (NNT 12–17/y to prevent 1 admission)
* Start steroids if: breathlessness interferes with activities of daily living
* Start antibiotics if: sputum changes colour/increases in volume/increases in thickness
* Make sure patient knows to book a review and to call for help if deteriorating on treatment
What is the first step of COPD inhaler therapy?
SABA or SAMA for prn relief
