Chronic obstructive pulmonary disease Flashcards
(59 cards)
Symptoms of COPD
dyspnoea, wheeze, chronic cough, regular sputum production
Main risk factor for developing COPD
smoking
Risk factors for developing COPD
Smoking, environment, occupational exposure, genetic factors (hereditarty alpha 1 antitrypsin deficiency), poor lung growth during childhood
Non drug treatment of COPD
- smoking cessation
- pulmonary rehabilitation
- breathing techniques
- Diet (to lower BMI)
What should all patients with COPD be offered annually?
Flu vaccine
Initial management of COPD
- Short acting bronchodilator SABA/ SAMA
Step up COPD treatment for patients without asthmatic features
- LABA or LAMA (continue SABA alongside but discontinue SAMA if starting a LAMA)
What criteria must a COPD patient (no asthma sx) meet before being initiated on ICS?
- Patients who are on a LABA/LAMA and require hospitilisation
- at least 2 moderate exacerbations (requiring systemic steroids / antibiotics) within a year
How often should COPD patients on ICS be reviewed?
Annually
If a patient has COPD (no asthma sx) and is on LAMA and LABA who feels their symptoms adversely effect their QOL what can be trialled?
ICS for 3 months
What can be offered as step up treatmetn for COPD patients with asthmatic symptoms
LABA + ICS
- if patient on a LABA + ICS has a severe exacerbation or 2 moderate exacerbations in a year add in a LAMA
What prophylactic antibiotic can be used in COPD?
Azithromycin ( used in patients who are non smokers and have had all other treatment options and continue to have frequent exacerbations)
What tests should be carried out before starting prophylactic Azithromycin in COPD patients?
ECG (rule out QT prolongation) sputum culture sensitivity CT scan of thorax LFTs at baseline review at 3 motnhs, 6 months
What drug can be used as an add on therapy to bronchodilator therapy in patients with severe COPD + chronic bronchitis?
Roflumilast
When should oral theophylline be used in COPD managment?
Only after a trial of SA + LA bronchodilators / if patient unable to use inhaled treatment
How is a severe COPD exacerbation managed?
- Rescue packs with an antibiotic + steroid
- prophylactic azithromycin can be continued during an acute exacerbation
- SABA via a nebuliser (withold LAMA if SAMA given)
- short course of pred 30mg
- Aminophylline should only be used as add on therapy if there is inadequate responce to nebulised bronchodilators
Example of a respiratory stimulant used in acute respiratory failure
Doxapram
What is the target concentration of oxygen in patients with carbon monoxide poisoning or in cardiac arrest?
Highest possible
If a patient is at risk of hypercapnic respiratory failure, what oxygen target should we aim for?
88-92%
Exmaple of a LAMA MDI
Spiriva ( tiotropium) Respimat 2.5mcg 2puffs OD
Example of a LAMA DPI
Eklira (aclidinium) Genuair - 1puff BD
Incruse (umenlidinium) Ellpipta - 1puff OD
Spiriva (tiotropium) handihaler 1puff OD
Seebri (glycopyrronium) Breezhaler - 1 ouff OD
Example of LABA MDI
- Atimos (Formoterol) MDI 1 puff BD
- Striverdi (Olodaterol) Respimat 2 puff OD
LABA DPI examples
Oxis (formoterol) 1 puff OD
Fomoterol easyhaler 1puff BD
LAMA + LABA MDI examples
Spiolto (tiotropium + olodaterol) respimat 2 puff OD
