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3.24 > Lecture 10: Pharmaceutical Care of People living with COPD > Flashcards

Lecture 10: Pharmaceutical Care of People living with COPD Flashcards

1
Q

What are the clinical indicators for considering a diagnosis of COPD?

A
  • Dyspnea that is progressive over time, worse with execrise, persistent
  • Recurrent wheeze
  • Chronic cough: may be intermittent and may be unproductive
  • Recurrent lower respiratory tract infections
  • History of risk factors
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2
Q

What are the COPD risk factors?

A
  • Tobacco smoke
  • Smoke from home cooking and heating fuels
  • Occupational dusts, vapors, fumes, gases and other chemicals
  • Host factors (genetic factors, developmental abnosrmalites…)
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3
Q

Compare the differences between CODP and asthma

A
  • Nearly all COPD have a smoking history, asthma patients not always
  • Symptoms under age of 35 are extremely rare for COPD patients and common for asthma
  • Chronic productive cough is common in COPD patients and uncommon in asthma patients
  • Breathlessness is progressive/ persistent in COPD but variable in asthma
  • Night time wakening breathlessness +/- wheeze is uncommon in COPD but common in asthmatics
  • Diurenal or day to day variability is uncommon in COPD but common in asthma
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4
Q

What are the pulmonary function tests?

A
  • Spirometry
  • FEV1
  • FVC
  • FEV1/FVC
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5
Q

What is the FEV1?

A

The FEV1 indicates the amount of air exhaled with maximum effort in the first second. Important in pre- and post-bronchodilator tests in determining the effects of bronchodilators on the airways

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6
Q

What is FVC?

A

The FVC is the total volume of air exhaled with maximal effort

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7
Q

What is used as a marker of progression of COPD?

A

FEV1/FVC

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8
Q

What is grade 1 on the MRC dyspnoea scale?

A

Not troubled except on strenuous exercise

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9
Q

What is grade 2 on the MRC dyspnoea scale?

A

Short of breath when hurrying on the flat or walking up a slight hill

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10
Q

What is grade 3 on the MRC dyspnoea scale?

A

Walks slower than most on the flat, stops after about a mile, or stops after walking 15mins at own pace

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11
Q

What is grade 4 on the MRC dyspnoea scale?

A

Stops for breath after walking 100 yards or a few minutes on the level

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12
Q

What is grade 5 on the MRC dyspnoea scale?

A

Too breathless to leave the house, or when undressing

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13
Q

What are the aims of management of stableCOPD

A
  • Reduce symptoms
  • Improve exercise tolerance
  • Improve health related quality of life
  • Prevent exacerbations
  • Provide a package of care that meets the patients needs
  • Provide treatment that minimises the risk of adverse effects
  • Reduce mortality
  • Prevent disease progression
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14
Q

What are the adjuncts to pharmacological management of COPD?

A
  • Smoking cessation
  • Pulmonary rehabilitation
  • Vaccination
  • Pneumococcal and influenza and COVID
  • Physiotherapy
  • Nutrition
  • Treatment of anxiety and depression
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15
Q

What are the fundamentals of COPD care?

A
  • Offer treatment and support to stop smoking
  • Offer pneumococcal and influenza vaccinations
  • Offer pulmonary rehabilitation if indicated
  • Co-develop a personalisaed self management plan
  • optimise treatment for comorbidities
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16
Q

What is offered to a patient if they are limited by symptoms or have exacerbations despite treatment and have no asthmatic featured or features suggesting steroid responsiveness?

A

LABA + LAMA

17
Q

What is offered to a patient with asthmatic features or features suggesting steroid responsiveness?

A

LABA + ICS

18
Q

What is offered to a person that has day to day symptoms that adversly impact quality of life?

A
  • Consider 3 month trial of LABA + LAMA + ICS
  • If no improvement, revert to LABA + LAMA
19
Q

What is offered to patients that have 1 severe or 2 moderate exacerbations in a year?

A

LABA + LAMA + ICS

20
Q

What are the adverse effects of corticosteroids?

A
  • Neuropsychological
  • Musculoskeletal
  • Endocrine and metabolic
  • Skin
  • Gastrointestinal
  • Ophthalmic
  • Immunosuppression
21
Q

When are corticosteroids use strongly favoured?

A
  • History of hospitilization for exacerbations of COPD
  • > 2 moderate exacerbation of COPD per year
  • Blood eosinophils > 300 cells/nl
  • History of, or conomitant asthma
22
Q

When are corticosteroids against use?

A
  • Repeated pnuemonie events
  • Blood eosinophils <100 cells/nl
  • Mycobacterial infection
23
Q

Which patients use SABA?

A

Used only in mild COPD but all patients will normally have a SABA inhaler

24
Q

When are LABA used?

A

Only used in combination with ICS (NICE ) or LAMA (NICE and GOLD)

25
Q

What LABA has a rapid onset?

A

Formoterol

26
Q

What are other treatments for COPD?

A
  • Theophylline
  • Mucolytics
  • Nebulised bronchodilators

3.24 (28 decks)

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