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S2 Respiratory System > Management of COPD > Flashcards

Management of COPD Flashcards

1
Q

what is COPD called when related to airflow obstruction?

A

chronic bronchitis

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2
Q

how reversible is chronic bronchitis?

A

not fully reversible

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3
Q

what is COPD called when related to hyperinflation of terminal bronchiole/alveoli?

A

emphysema

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4
Q

what is the effect of having lots of neutrophils and elastase?

A

tissue damage

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5
Q

what does an increased number of alveolar macrophage do?

A

increased alveolar macrophage, elastase and metallo-proteinases provoke tissue damage

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6
Q

what causes tissue damage in COPD?

A

increased neutrophil and elastase in the blood, increased alveolar macrophage, elastase and metallo-proteinases in the alveoli

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7
Q

what causes increase in elastase?

A

congenital alpha-1-AT deficiency and ‘functional’ alpha-1-AT deficiency

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8
Q

what causes ‘functional’ alpha-1-AT deficiency?

A

inactivation of antiproteases caused by reactive oxygen species (‘free radicals’)

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9
Q

what causes increase in neutrophils?

A

nicotine and IL-B, LT4 and TNF

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10
Q

what releases nicotine and reactive oxygen species?

A

tobacco

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11
Q

what are the main respiratory symptoms for COPD?

A

chronic cough, exertional breathlessness, sputum production, frequent “winter” bronchitis, wheeze, chest tightness and recurrent chest infection

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12
Q

what none-respiratory symptoms does COPD cause?

A

loss of muscle mass, weight loss, cardiac disease, depression, anxiety etc

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13
Q

patient bio- when to suspect COPD?

A

aged 35 or more, current or former smokers

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14
Q

what are the clinical differences between COPD and asthma in terms of age difference?

A

COPD: >35 years
asthma: any age

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15
Q

what are the clinical differences between COPD and asthma in terms of cough?

A

COPD: persistent and productive
asthma: intermittent and non-productive

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16
Q

what are the clinical differences between COPD and asthma in terms of smoking history?

A

COPD: invariably always one
asthma: possible

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17
Q

what are the clinical differences between COPD and asthma in terms of breathlessness?

A

COPD: progressive and persistent
asthma: intermittent and variable

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18
Q

what are the clinical differences between COPD and asthma in terms of nocturnal symptoms?

A

COPD: uncommon unless in severe disease
asthma: common

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19
Q

what are the clinical differences between COPD and asthma in terms of family history?

A

COPD: uncommon unless family members also smoke
asthma: common

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20
Q

what are the clinical differences between COPD and asthma in terms of presence of concomitant eczema or allergic rhinitis?

A

COPD: possible
asthma: common

21
Q

what should the clinician observe when looking for COPD?

A

normality in normal stages, reduced chest expansion, prolonged expiration/ wheeze, hyper inflated chest, respiratory failure (tachypnoea, cyanosis, use of accessory muscles, pursed lip breathing, peripheral oedema)

22
Q

what is tachypnoea?

A

abnormally fast breathing

23
Q

what is cyanosis?

A

bluish discolouration of skin/ mucous membranes due to excessive concentration of desoxyHb

24
Q

what test enables confirmation of diagnosis and assessment of severity?

A

spirometry

25
Q

what respiratory disorder is present if FEV1/FVC < 70%?

A

obstructive

26
Q

what respiratory disorder is present if FEV1/FVC > 70%?

A

none or restrictive

27
Q

what respiratory disorder is present if FEV1/FVC < 70% and FEV1 > 80%?

A

no disorders

28
Q

what respiratory disorder is present if FEV1/FVC < 70% and FEV1 < 80%?

A

restrictive, the lower the FEV1 the more severe

29
Q

what other baseline tests are there for COPD?

A

chest X-ray, ECG, full bloom count, BMI, A1AT test?

30
Q

how do you relieve breathlessness?

A

inhalers

31
Q

how do you prevent exacerbation?

A

inhalers, vaccines, pulmonary rehabilitation (PR)

32
Q

how do you manage complications of COPD?

A

long term oxygen therapy

33
Q

how do you prevent disease progression?

A

smoking cessation

34
Q

how to manage COPD without pharmacological involvement?

A

pulmonary rehabilitation

35
Q

name two short acting bronchodilators

A

SABA (salbutamol), SAMA (ipratropium)

36
Q

name two long acting bronchodilators

A

LAMA (long acting anti-muscarinic agents (umeclidinium, tioptropium), LABA (long acting B2 agonist (salmeterol))

37
Q

high dose inhaled corticosteroids (ICS) and LABA

A

relvar (fluticasone/ vilanaerol), fostair MDI

38
Q

which inhaler treatment is the first line of treatment for COPD?

A

SABA

39
Q

when would you use LAMA or LABA?

A

as 2nd line of treatment

40
Q

when would you use LAMA and LABA?

A

as 3rd line of treatment

41
Q

when would you use triple therapy? (ICS, LABA and LAMA)

A

as last resort (if FEV1 decreases and symptoms & exacerbations increase)

42
Q

under which conditions would a patient need long term oxygen (LTOT)?

A

PaO2 < 7,3 kPa or PaO2 7,3-8kPa if polycythaemia, nocturnal hypoxia, peripheral oedema, pulmonary hypertension

43
Q

what is exacerbation?

A

sudden worsening of symptoms due to infection or environment. Causes increasing breathlessness, cough, sputum volume and purulence increase, wheeze, chest tightness (neutrophil increase releases elastase)

44
Q

which steroid and in which quantity should be prescribed if Acute Exacerbating factors in COPD (AECOPD) appear?

A

prednisolone 40 mg per day for 5-7 days

45
Q

under which conditions in AECOPD should antibiotics be prescribed?

A

if there is evidence of infection (fever, increase in volume/ purulence of sputum)

46
Q

when should hospital admission be considered in AECOPD?

A

tachypneoa, low O2 saturation (<90-92%), hypotension etc

47
Q

how do you manage AECOPD on the wards?

A

oxygen with 88-92% saturation, nebuliser bronchodilatators, corticosteroids, antibiotics (oral vs IV), assess for evidence of respiratory failure (clinical/ arterial blood gas (ABG))

48
Q

which investigations would you conduct for a patient recently admitted in hospital for AECOPD?

A

full blood count, biochemistry and glucose, theophylline concentration, arterial blood gas, ECG, CXR, blood culture for febrile patients, sputum microscopy, culture and sensitivity

S2 Respiratory System (43 decks)

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