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Medicine - Year 1 - Term 2 > W2 - COPD Features and Management > Flashcards

W2 - COPD Features and Management Flashcards

1
Q

Name the 6 symptoms of COPD

A

Weight loss
Wheeze
Chronic dyspnoea
Cough
Sputum
Chest tightness

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2
Q

COPD is a combination of which 2 conditions, and what are they physiologically?

A

Chronic bronchitis - inflammation of bronchi

Emphysema - destruction of alveoli leading to loss of elasticity

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3
Q

How many people in the UK have COPD? How many in the world?

A

1.2m in UK (more in Scotland than England)

80m worldwide have moderate to severe COPD

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4
Q

Name 3 modifiable aetiological factors of COPD

A

Smoking

Lower income country (due to biomass fuel cooking and heating)

Air pollution

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5
Q

Name 8 non- modifiable aetiological factors of COPD

A

Female
Increase in age
Lower socioeconomic status
Asthma/airway hyper-reactivity
Chronic bronchitis
Childhood infection
Smaller lungs
Alpha-1 antitrypsin deficiency

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6
Q

What is AAT?

A

Alpha-1 antitrypsin is a protease inhibitor made in the liver

Toxins from inhaled cigarettes/infection are engulphed by neutrophils which release elastase. Normally, AAT mops up elastase

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7
Q

What 3 signs may indicate alpha-1 antitrypsin deficiency?

A

Someone young with COPD features

Basal predominance to emphysema

Association with liver fibrosis or cirrhosis

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8
Q

What % of smokers develop COPD? Which graph shows lung function vs age in smokers, stoppers and non-smokers?

A

Around 50% of smokers develop COPD

The Fletcher-Peto Curve

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9
Q

Name 3 uncommon symptoms of COPD

A

Weight loss
Fatigue
Swollen ankles

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10
Q

Name 9 signs of COPD

A

Cyanosis
Raised jugular venous pressure
Cachexia
Wheeze
Pursed lip breathing
Chest wall deformities
Hyperinflated chest
Use of accessory muscles
Peripheral oedema

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11
Q

What’s the clinical diagnosis for chronic bronchitis, “stereotype” and 6 symptoms?

A

Chronic bronchitis - daily productive cough for 3+ months, in at least 2 consecutive years

“Blue bloater”

Overweight
Cyanotic
Elevated haemoglobin
Peripheral oedema
Rhonchi
Wheezing

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12
Q

What’s the pathological diagnosis for emphysema, “stereotype” and 6 symptoms?

A

Permanent enlargement and destruction of airspaces distal to terminal bronchiole

“Pink puffer”

Older
Thin
Severe dyspnea
Quiet chest
Xray shows hyperinflation with flattened diaphragm

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13
Q

What are the 5 clinical criteria to diagnose COPD

A

Typical symptoms
35+
Presence of risk factors
Absence of clinical features of asthma
Airflow obstruction confirmed by post-bronchodilator spirometry

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14
Q

What are the 4 (and a bit!) stages of COPD, including FEV1 compared to predicted values?

A

Stage 1 - Mild - 80%
Stage 2 - Moderate - 50-79%
Stage 3 - Severe - 30-49%
Stage 4 - Very Severe - less than 30%

End stage COPD - not part of classification but often used in practice

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15
Q

What score do we use to classify COPD?

A

GOLD score

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16
Q

What 5 signs on a chest xray indicate COPD

A

Vascular hila
Hyperinflation
Bulla (reduced lung markings)
Small heart
Flattened diaphragm

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17
Q

How many ribs can we count in an xray showing hyperinflation?

A

6+ anterior ribs
10+ posterior ribs

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18
Q

What 6 things can we ask in a clinical history of COPD?

A

Tell me about your cough
What about breathlessness
Did you/anyone in your family have allergies, hay-fever or eczema
Did you have any childhood chest problems
Exposure history

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19
Q

Name 6 pathophysiological causes of COPD

A

Thickening, irritation and inflammation of bronchi and bronchioles

Hypersecretion

Mucociliary dysfunction

Airflow obstruction caused by narrowing bronchi

Decrease in lung elastic recoil due to destruction of lung parenchyma causing loss of alveolar attachment

Increased physiological dead space

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20
Q

Describe ventilation and perfusion in COPD and what causes it

A

Matched - mucus reduces ventilation, emphysema destroys alveoli, reducing perfusion

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21
Q

Describe 7 severe COPD and complications

A

Hypercapnea can lead to drowsiness, flapping tremor and ventilatory failure (after becoming acidotic)

Hypoxic drive

Cor pulmonale

Secondary polycythaemia

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22
Q

What is cor pulmonale?

A

Right sided heart failure due to lung disease

Alvolar hypoxia causes compensatory vasoconstriction to shunt blood to healthy alveoli. Over a long period pressure can build up in pulmonary arteries.

Smoking damages vasculature of heart. Heart muscle thickens, increasing pressure on left slide of heart, increasing jugular venous pressure and impairing left ventricle, reducing circulating blood volume.

Kidney compensation is activated (aldosterone and angiotensin system) leading to fluid retention

23
Q

What is secondary polycythaemia

A

Response to chronic hypoxia. Body detects low O2 and produces more RBCs, increasing erythropoietin in kidneys causing increased blood viscosity, strokes, etc.

24
Q

Name 6 UK anti-smoking legislation public health measures

A

Raising age at which tobacco can be purchased

Picture warnings on cigarette packets

Tobacco vending machines banned

Tobacco displays banned in large stores

Ban on smoking in cars carrying children

Standardised smoking packaging

25
Q

If you’re not sure if a patient has COPD, what 2 pulmonary function tests can you do, and what would the results be for COPD? What test can you do if still unsure?

A

Lung volume test
- Increased residual volume
- Increased total lung capacity
- RV/TLC >30%

Transfer factor
- Reduced gas transfer
- Reduced Dlco
- Reduced Kco

If still unsure, do HRCT of upper zone of lung

26
Q

On HRCT, what 6 signs indicate COPD?

A

Signet ring sign
Honeycombing
Traction bronchiectasis
Lung cysts
Centrilobular emphysema
Paraseptal emphysema

27
Q

In primary care when managing acute COPD, what 9 symptoms can worsen?

A
  • SOB
    • Wheeze
    • Chest tightness
    • Cough
    • Sputum
    • Unable to smoke
    • Systemic upset - eating, drinking, ADLs
    • Temperature (if infective)
      Fatigue
28
Q

In primary care when managing acute COPD, what 8 signs and symptoms indicate a severe exacerbation?

A
  • Breathless (RR>22/min)
    • Accessory muscle use
    • Purse lip breathing
    • Cyanosis (Sats <92% o/a)
    • Significant decrease in exercise tolerance
    • Signs of sepsis (if infective)
    • Fluid retention
    • Confusion
29
Q

When managing acute COPD in secondary care, what 4 triggers should we look out for?

A

Bacterial/viral infection
Sedative drugs
Pneumothorax
Trauma

30
Q

When managing acute COPD in secondary care, what 8 signs and symptoms should we look out for?

A

Confusion
Cyanosis
Severe breathlessness
Flapping tremor
Drowsy
Pyrexial
Wheeze
Tripod position

31
Q

When managing acute COPD in secondary care, what 6 investigations can we do?

A

CXR
Blood gases
FBC
U&E
Sputum culture
VTS

32
Q

When managing acute COPD in secondary care, what 4 treatments could we consider? What 1 other thing can we do?

A

O2
Nebulised bronchodilator (B2 and anti-muscarinic)
Oral/IV corticosteroid
+/- antibiotic (IV aminophylline, respiratory stimulant, NIV)

Treat any co-existing conditions

33
Q

What 2 tools can we use to assess severity of COPD?

A

COPD Assessment Tool (CAT)
mMRC Breathlessness Scale

34
Q

When assessing severity of COPD, what 2 things can we look out for?

A

History of moderate and severe exacerbations and future risk (number per year, hospitalisation)

Presence of co-morbidities (heart disease, atrial fibrillation, obesity)

35
Q

The COPD Assessment Test asks about what 8 things?

A

Cough
Mucus
Chest tightness
Breathless upon exertion
Limitation of activity
Confidence leaving home
Sleep interruption
Energy level

36
Q

COPD Assessment Test scores indicate what?

A

0-9 Low
10-20 Medium
21-30 High
31-40 Very high

37
Q

What are the grades for the mMRC breathlessness scale?

A

0 - breathless on exertion
1 - SOB when hurrying
2 - stop for breath
3 - stop for breath after every few mins
4 - too breathless to leave house

38
Q

What can we treat for COPD?

A

Improve exercise tolerance
Prevent exacerbations
Nutrition/weight loss
Complications
Anxiety/depression
Co-morbidities
Dysfunctional breathing
Palliative care

39
Q

What 5 non-pharmacological aspects can we manage in COPD?

A

Pulmonary rehabilitation
Smoking cessation
Vaccination
Nutritional assessment
Psychological support

40
Q

Name 4 types of classes of drugs for managing COPD

A

Short-acting bronchodilators
Long-acting bronchodilators
High dose inhaled corticosteroids (ICS)
Long Term Oxygen (LTOT)

41
Q

Name 2 types of short acting bronchodilators and give an example of each

A

SABA, e.g. salbutamol
SAMA, e.g. ipratropium

42
Q

Name 2 types of long acting bronchodilators and give 2 examples of each

A

LAMA (long-acting anti-muscarinic agent), e.g. umeclidinium, tioptropium

LABA (long-acting anti-muscarinic agent), e.g. salmeterol, formoterol, olodaterol

43
Q

Name 2 types of high dose inhaled corticosteroids give an example of each

A

Relvar, i.e. fluticasone, vlianterol
Fostair MDI

44
Q

Which 3 methods are the cheapest ways to treat COPD?

A

Flu vaccination (£1000)
Stop smoking support with pharma (£2000)
Pulmonary rehabilitation (£2000-£8000)

45
Q

Which 3 methods are the most expensive ways to treat COPD?

A

Telehealth (£32,000)
Triple therapy (£7000-£187,000)
LABA (£8000)

46
Q

What 3 categories of medicines can we give to manage COPD exacerbation?

A

Short acting bronchodilators
Steroids
Antibiotics (if evidence of infection)

47
Q

In COPD exacerbation management, consider hospital admission if any of what 5 criteria are present?

A

Tachypnoea
Low oxygen sats (<90-92)
Hypotension
Cyanosis
Acute confusion

48
Q

In ward-based management of COPD exacerbation, what 4 treatments can we offer? What complication should we look for and how can we look for it?

A

O2 (only if sats are 88-92% as lower suggests hypoxic drive)
Nebulised bronchodilators
Corticosteroids
Antibiotics

Look for resp failure - clinical or arterial blood gas

49
Q

What 2 complications of COPD should we look for in hospital admission and what’s the treatment?

A

Acute respiratory failure

Hypoxia and CO2 retension

Treat with non-invasive ventilation (NIV)

50
Q

What 8 methods can we use to investigate COPD exacerbation?

A
  • FBC
    • Biochem and glucose
    • Theophylline concentration (in patients using theophylline preparation)
    • Arterial blood gas (documenting amount of O2 delivered and by what delivery device)
    • Electrocardiograph
    • Chest X-ray
    • Blood cultures in febrile patients
      Sputum microscopy, culture and sensitivity
51
Q

Name 4 platforms of patient education in the management of COPD

A

My COPD
My Lungs My Life
Don’t Waste a Breath
No Delays

52
Q

In what 4 ways can patients self-manage COPD on the My COPD app?

A

Info regarding condition
Managing symptoms
Inhaler techniques
When to seek medical advice

53
Q

In what ways can we manage breathlessness and dysfunctional breathing in the palliation of COPD?

A

Pharmacological, e.g. morphile, lorazepam (anxiety)
Psychological support
Palliative care referral

54
Q

In what 3 ways can we create an anticipatory care plan in the palliation of COPD?

A

Hospital admission
Ceiling of treatment
DNACPR

Medicine - Year 1 - Term 2 (13 decks)

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