Wk 14: COPD Flashcards
What are the signs + symptoms of COPD?
- Exertional breathlessness
- Chronic cough
- Regular sputum prod
- Frequent winter bronchitis
- Wheeze
- Chest tightness
- Fatigue
What are the complications of COPD?
- HF
- Respiratory failure
- Sleep apnoea
- Repeated respiratory infections
- Osteoporosis
When would you consider a diagnosis of COPD?
- > 35
- Smoker/ex-smoker
- symptoms
What would you use to confirm a diagnosis of COPD?
Post-bronchodilator spirometry
When would you consider/not consider a diagnosis of COPD using the spirometry?
- Alt diagnose: older people w/ FEV1/FVC ratio below 0.7 + no typical symptoms
- Diagnose: younger people w/ symptoms but FEV1/FVC ratio above 0.7
What indicates a restrictive effect (lung fibrosis) using the spirometry?
- FVC red + FEV1/FVC ratio >80%
- Lung vol red
What indicates an obstructive effect (asthma/COPD) using the spirometry?
- FEV1 red more than FVC + FEV1/FVC ratio <80%
- FEV1 < 80% predicted
Other than spirometry, what other measures are taken when diagnosing a patient?
- Chest radiograph (exclude pathologies)
- FBC (anaemia/polycythaemia)
- BMI
What is the dyspnoea scale?
- Not troubled by breathlessness except strenuous exercise
- SOB hurrying/walking slight hill
- Walks slower on level ground bc breathless/stops for breath walking own pace
- Stops for breath after 100m or few mins on level ground
- Too breathless to leave house/dress
What is the GOLD classification of COPD?
- Gold 1 (mild): FEV1 >80% predicted
- Gold 2 (moderate): 50% < FEV1 <80% predicted
- Gold 3 (severe): 30% < FEVs < 50% predicted
- Gold 4 (v severe): FEV1 <30% predicted
When managing a patient, what lifestyle advise would you give a patient?
Self management plan:
- Stop smoking
- Comply w/ meds
- Regular exercise/pulmonary rehab
- Regular flu vaccine + pneumococcal vaccine
What would you offer for smoking cessation?
- NRT
- Bupropion
- Varenicline: for smokers w/ desire to quit
When would you offer long term oral corticosteroids?
Advanced COPD that cannot be w/drawn following exacerbation - low dose
What would you monitor/offer alongside oral corticosteroids?
- Osteoporosis
- Start prophylaxis w/o monitoring if >65
When would you offer theophylline?
- Trial of short acting bronchodilators + long acting bronchodilators
- Unable to use inhaled therapy
When would you be cautious when giving theophylline?
- Older: inc interactions
- Macrolide/fluoroquinolone antibiotics: red dose
When would you consider offering a mucolytic drug?
- Chronic cough productive sputum
- Continue if improvement
- Don’t routinely use if stable
What prophylactic antibiotic is given to people with COPD?
Azithromycin 250mg 3 times a week
Who would you only give prophylactic azithromycin to?
- Don’t smoke AND
- Optimised non-pharmacological management, inhaled therapies, vaccines + referred for pulmonary rehab AND
- Frequent (4x year) exacerbations w/ sputum OR
- Prolonged exacerbation w/ sputum
- Exacerbation = hospital
What is used to monitor patients progress + during exacerbations?
- Oxygen sats (97-99%)
- Refer if sp02 <92% on more than 1 occasion
When would you be cautious when giving oxygen to COPD patient?
Red alveolar ventilation w/ low PaO2 + high PaCO2
- Cyanosed but not breathless
- Respiratory centres insensitive to CO2
- Rely on hypoxic drive to maintain respiration
What is the target oxygen saturation in a patient with COPD, chest wall deformities + morbidly obese?
88-92%
Why is 88-92% the target?
- Uncontrolled oxygen red depth + freq. breathing
- Leads to rise in blood CO2 levels + fall in pH
- Controlled oxygen: delivery service at flow rate that helps oxygen maintained btw 88-92%
What are symptoms of exacerbations?
- Worsening breathlessness/dyspnoea
- Cough
- Inc sputum
- Change in sputum colour
What is first line choice of oral antibiotics?
- Amox: 500mg TDS 5 days
- Doxy: 200mg 1st day then 100mg for 5 day course
- Clarith: 500mg BD 5 days
What is the self management treatment for exacerbation?
- Oral corticosteroid if inc breathlessness
- Antibiotic if sputum purulent
- Adjust bronchodilator to control symptoms
Who would you refer to if a patient is stable with COPD + has exercise limitations due to breathlessness?
Pulmonary rehabilitation programme:
- Multidisciplinary interventions
- Physical training
- Disease education
- Nutritional, psychological + behavioural intervention
