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
Other therapies for COPD
Vaccinations e.g. pneumococcal, influenza
Mucolytics e.g. carbocysteine
What happens when COPD is exacerbated?
Worsening breathlessness
Cough
Increased sputum production
Change in sputum colour
Worsening peripheral oedema
Triggers of COPD exacerbations
How to manage exacerbations of COPD?
Bronchodilators - increase frequency
Oral corticosteroids - prednisolone
Antibiotics
Oxygen
How to prevent exacerbations of COPD?
Give self-management advice
Rescue packs
Sputum colour
