COPD Flashcards
What is COPD?
General term encompassing a number of diseases esp. chronic bronchitis and emphysema; non-reversible, progressive
Effects of chronic bronchitis
Lung damage and inflammation in airways
Cough with sputum production
Hyperplasia and hypertrophy of goblet cells and mucus glands
Scarring and remodelling of lung tissue»_space;> loss of elasticity
Hypoxia/ cyanosis resulting in blue tinge to lips and skin
Effects of emphysema
Lung damage and inflammation of alveoli
Enlargement of the air spaces distal to the terminal bronchioles
Reduced surface area and elasticity
Airways collapse
Effort for breathing results in a pink flush in the face
Prevalence of COPD
Approximately 1 million in England and Wales
Stable prevalence in men, increasing in women
1 in 8 acute admissions
30,000 direct deaths per year
Risk factors
Exposure to tobacco smoke, occupational dusts/ chemicals, indoor/ outdoor pollution, infections; host factors: alpha1 antitrypsin deficiency, airways hyper responsiveness, age/gender; socio-economic status
Associated co-morbidities
Weight loss, nutritional abnormalities, skeletal muscle dysfunction, MI, angina, osteoporosis, respiratory infection, sleep disorders, depression, diabetes, anaemia, glaucoma
A diagnosis of COPD should be considered in patients:
Over the age of 35, who have a risk factor (generally smoking), and who present with exertional breathlessness, chronic cough, regular sputum production, frequent winter bronchitis or wheeze
Possible investigations
Spirometry History and examination Chest x-ray FBC BMI
FEV1
FVC
Forced Expiratory Volume in 1 second
Forced Vital Capacity
Airflow obstruction is defined as:
A reduced FEV1 < 80% predicted
and a reduced FEV1/FVC ratio < 0.7
Reversibility testing
A large (>400mL) response to bronchodilators A large (>400mL) response to 30mg oral prednisolone daily for 2 weeks Serial peak flow measurements showing 20% or greater diurnal or day to day variability Clinically significant COPD is not present if the FEV1 and FEV1/FVC ratio return to normal with drug therapy
Assessing disease severity using FEV1
Mild >80%
Moderate 50-80%
Severe 30-49%
Very severe <30%
Smoking cessation effects
Slows disease progression Does not restore loss of lung function Can be used as primary prevention Sudden cessation better than gradual Advice and behavioural modification useful Important role for pharmacists with NRT
Pharmacological treatment of COPD
Inhaled bronchodilators, inhaled corticosteroids, oral corticosteroids, theophylline, combination therapy
Further treatment of COPD
Oxygen therapy, mucolytics, antidepressants, surgery, palliative care
