Treatment of COPD Flashcards
What is COPD?
Chronic obstructive pulmonary disease
Progressive airflow obstruction
Not fully reversible
No cure - only to reduce symptoms
Caused by smoking
How do you calculate pack years?
> 20 = heavy smoker
The risk factors of COPD
Age
Gender
Occupation
Air pollution
Genetic factors
Socio-economic status
Pathophysiology of COPD
When breathing in particles or gases, it causes inflammation.
Inflammation induces:
- airflow limitation + trapping
- mucus hypersecretion
- gas exchange abnormalities
How do you diagnose COPD?
No single diagnostic test
Rely on clinical judgement
- Patient history (>35 years, risk factors - smoking)
- Physical exam - signs + symptoms
- Spirometer - confirms airflow obstruction (FEV1/FVC)
- X-ray
What are the symptoms of COPD?
Breathlessness
Chronic cough
Regular sputum production
Frequent winter chest infections
Wheeze
What are the signs of COPD?
Older patient (>35 years) - onset of symptoms later in life
Hyperinflated lungs (air trapped in lungs barrel chest)
Wheeze/quiet sounds
Pursed-lip breathing
Peripheral oedema
Cyanosis (blue lips = low O2 levels)
Nicotine staining in fingers + nails
Underweight
What is spirometry?
Measure the patient’s lung function
It is performed at
- time of diagnosis
- to reconsider diagnosis after response to treatment
FEV<strong>1</strong> - forced expiratory volume in one second
FVC - forced vital capacity = maximum volume of air that can be exhaled from the lung
Airflow obstruction = <0.7 ratio
Severity of airflow obstruction
Name bronchodilators for the treatment of COPD
Inhaled corticosteroids
Reduce inflammation
(do not modify long-term lung function decline)
Benefit if FEV1 < 50% + frequent exacerbations
- 2+ per year that require antibiotics/oral steroids
None are currently licensed for use alone
Side effects of inhaled corticosteroids
Pneumonia
Adrenal suppression
Diabetes
Osteoporosis
What to do before stepping up a patient’s therapy?
Patient’s inhaler technique
Adherence to therapy
Smoking status
Attendance + pulmonary rehabilitation
Signs of anxiety/depression
What is Theophylline?
Used after failure of previous treatment
Anti-inflammatory
Need to monitor plasma levels
What is LTOT?
Long-term oxygen therapy
At least 15 hours/day
Smokers
Triggers of COPD exacerbations
