Case 10 LOL

Question 1

What is diagnosis of COPD based on?

Answer 1

symptoms
•breathing sounds
•smoking history 
•BMI
•family history of lung problems
•breathing tests e.g. spirometry

Question 2

What tests can be used to diagnose COPD?

Answer 2

Spirometry
Chest x-ray
Blood tests
electrocardiogram (ECG)
echocardiogram;
peak flow test;
blood oxygen test
CT scan
phlegm sample

Question 3

How does spirometry work?

Answer 3

Takes 2 measurements:
1.the volume of air you can breathe out in a second(FEV1)
2.total amount of air you breathe out(FVC)
On a time volume graph, FEV1 is worked out by finding y reading from x=1. FVC is the highest point of the curve

Question 4

What does a blood test test for?

Answer 4

Anaemia
Polycythaemia
alpha-1-antitrypsin deficiency

Question 5

What are the main inhalers used for COPD?

Answer 5

Short-acting bronchodilator inhalers
Long-acting bronchodilator inhalers
Steroid inhalers

Question 6

What is a Short-acting bronchodilator inhaler?

Answer 6

First treatment
Used when you feel breathless upto max 4 times a day
2 types:
beta-2 agonist inhalers-such as salbutamol and terbutaline
antimuscarinic inhalers-such as ipratropium

Question 7

What is a long-acting bronchodilator?

Answer 7

for people who experience symptoms regularly throughout the day
Each dose lasts for at least 12 hours, so they only need to be used once or twice a day

There are 2 types of long-acting bronchodilator inhalers:

beta-2 agonist inhalers-such as salmeterol, formoterol and indacaterol

antimuscarinic inhalers-such as tiotropium, glycopyronium and aclidinium

some new inhalers contain a combination of a long-acting beta-2 agonist and antimuscarinic

Question 8

What are steroid inhalers?

Answer 8

or people who still become breathless when using a long-acting inhaler, or they have frequent flare-ups(exacerbations)

Steroid inhalers are normally prescribed as part of a combination inhaler that also includes a long-acting medicine

Question 9

What tablets can be used to treat COPD?

Answer 9

Theophylline tablets
Mucolytics
Steroid tablets
Antibiotics

Question 10

What are Theophylline tablets?

Answer 10

Type of bronchodilator

Relaxes muscles of airway and reduces inflammation

Question 11

How do mucolytics work?

Answer 11

E.g. carbocisteine
Makes phlegm thinner and easier to cough up
If carbocisteine doesn’t help try acetylcysteine- powder that you mix with water

Question 12

How do steroid tablets work?

Answer 12

If you have a particularly bad flare-up, you may be prescribed a short course of steroid tablets to reduce the inflammation in your airways.
A 5-day course of treatment is usually recommended

Question 13

What does pulmonary rehabilitation involve?

Answer 13

Physical exercise training
Education about condition
Dietary advice
Physiological and emotional; support

Question 14

What is a nebuliser?

Answer 14

a machine is used to turn liquid medicine into a fine mist that you breathe in through a mouthpiece or a face mask
Enables large dose of medicine to be taken at once

Question 15

What is roflumilast?

Answer 15

Medicine that treats flare-ups
Recommended for people whose symptoms have suddenly become worse at least 2 times over the past 12 months, and who are already using inhalers
Comes as a tablet

Question 16

What is long-term oxygen therapy?

Answer 16

If COPD causes you to have low levels of oxygen in blood you may be given oxygen at home
Should be used for at least 16 hours a day
Portable oxygen tanks if away from home

Question 17

What is ambulatory oxygen therapy?

Answer 17

Oxygen for when you walk or are active

Given for those whose oxygen levels are fine at rest but fall when active

Question 18

What is non invasive ventilation?

Answer 18

Used if you’re taken to hospital for bad flare up

Portable machine connected to mask that covers nose or face used

Question 19

What surgeries can be used to treat COPD?

Answer 19

1. bullectomy-removes a pocket of air from one of the lungs, allowing the lungs to work better and make breathing more comfortable
2. lung volume reduction surgery-removes a badly damaged section of lung to allow the healthier parts to work better and make breathing more comfortable
3. lung transplant-removes and replaces a damaged lung with a healthy lung from a donor

Question 20

How may you have to adjust your daily life to live with COPD?

Answer 20

Take prescribed medicine
Stop smoking
Exercise regularly
Maintain healthy body weight
Get vaccinated
Check weather
Watch what you breath (e.g. dust)
Regular review and monitoring
Breathing techniques
Talk to others
Money and financial support
End of life care

Question 21

What are comorbidities of COPD?

Answer 21

Cardiovascular Disease
Diabetes and Metabolic Syndrome
Osteoporosis
Lung Cancer
Depression
Sleep Disorders
Medication Reconciliation

Question 22

What features might we see on a chest x-ray for someone with pneumonia?

Answer 22

Opacification

Loss of meniscus

Question 23

What features might we see on a chest x-ray for someone with pleural effusion?

Answer 23

A large part of one lung now appears as opaque

Question 24

What may an ABG show us?

Answer 24

low pH: acidemia
high pH: alkalemia
Low pH with high PCO2: Respiratory acidosis
Low pH with low HCO3: metabolic acidosis
High pH with low PCO2: respiratory alkalosis
High pH with high PCO2: metabolic alkalosis

Question 25

What is type 1 respiratory failure?

Answer 25

Failure of lungs and heart to provide adequate O2 to meet metabolic need

Question 26

What is type 2 respiratory failure?

Answer 26

Failure of lungs to eliminate adequate CO2

Question 27

What is CPAP?

Answer 27

Continuous positive airway pressure
Receive the same amount of pressure as you breath in and out
Helps just with inhalation
Not used for COPD

Question 28

What is BiPAP?

Answer 28

Bi-level positive airway pressure
Positive airway pressure received when you breath both in and out. Higher air pressure when you breath in.
Helps with inhalation and exhalation
Helps oxygenation and allows CO2 to be expelled
Used for COPD

Question 29

What are causes of peripheral oedema?

Answer 29

1. Alveolar hypoxia
2. Hypoxic pulmonary vasoconstriction
3. Pulmonary vascular resistance
4. Pulmonary hypertension
5. Right ventricular afterload
6. Right ventricular failure
7. Peripheral oedema
8. Swelling of ankles and feet

Question 30

What is cor pulmonale?

Answer 30

right-sided heart failure may develop due to pulmonary hypertension
blood can’t get backed up in the veins throughout your body
as fluid leaks into the surrounding tissues, oedema develops
due to the effects of gravity, fluid starts to pool in the lowest parts of your body -feet, ankles, and legs, making them swell

Question 31

What is pulmonary hypertension?

Answer 31

occurs when lung disease causes high pressure in the blood vessels of the lungs

Therefore,the right side of your heart (which moves blood between the heart and lungs) has to work a lot harder to pump