Chronic Obstructive Pulmonary Disease (COPD) Flashcards
(113 cards)
1
Q
What is chronic obstructive pulmonary disease (COPD)?
A
It is defined as an irreversible condition in which there is a gradual deterioration of air flow through the lungs, due to damaged lung tissue
2
Q
What is the COPD triad?
A
Emphysema
Chronic bronchitis
Small airway fibrosis
3
Q
What is emphysema?
A
It is defined as a condition in which inner walls of the alveoli weaken and rupture, creating enlarged air spaces
4
Q
What is chronic bronchitis?
A
It is defined as a cough with sputum production for at least three months in two consecutive years
5
Q
What are the four risk factors for COPD?
A
Smoking
Middle Aged > 35 Years Old
Alpha-1 Antitrypsin (AAT) Deficiency
Air Pollution
6
Q
What is the most common risk factor for COPD?
A
Smoking
7
Q
How does smoking cause COPD?
A
It inactivates alpha-1 antitrypsin , which causes emphysema
8
Q
What is the inheritance of AAT deficiency?
A
Autosomal dominant
9
Q
What is AAT deficiency? Explain how it is a risk factor of COPD
A
AAT is a protease inhibitor, which functions to prevent neutrophil elastase from breaking down alveolar structures
Therefore, AAT deficiency results in increased destruction of alveolar structure - precipitating emphysema development
10
Q
Does AAT deficiency result in early or late onset COPD?
A
Early onset < 45 yrs old
11
Q
What other organ tends to be affected by AAT deficiency?
A
Liver, resulting in cirrhosis
12
Q
What are the six clinical features of COPD?
A
Progressive Dyspnoea
Chronic Productive Cough
Wheeze
Recurrent LRTIs
Peripheral Oedema
Tachypnoea
13
Q
Describe the sputum associated with COPD
A
Colourless
However, may be green during infection
14
Q
Why is peripheral oedema a clinical feature of severe COPD?
A
In severe COPD, cor pulmonale (right sided heart failure) can develop which leads to peripheral oedema
15
Q
Which clinical feature is used to differentiate between COPD and heart failure?
A
Heart failure = orthopnea
16
Q
What scoring system can be used to assess the severity of dyspnoea?
A
Medical Research Council (MRC) Dyspnoea Scale
17
Q
What scoring system can be used to assess the impact of COPD on a patients wellbeing and daily life?
A
COPD Assessment Test (CAT) Score
18
Q
What six investigations are used to diagnose COPD?
A
Spirometry
Blood Tests
Arterial Blood Gas (ABG)
Sputum Culture
Chest X-Ray (CXR)
ECG Scan
19
Q
What is spirometry?
A
It measures the volume and flow of air during exhalation and inhalation
20
Q
What three metrics can be obtained with spirometry?
A
Forced Expiratory Volume 1 (FEV1)
Forced Vital Capacity (FVC)
FEV1 : FVC
21
Q
What is FEV1?
A
It is defined as the volume that has been exhaled at the end of the first second of forced expiration
22
Q
What is FVC?
A
It is defined as the volume that has been exhaled after a maximal expiration, following a full inspiration
23
Q
What spirometry result indicates COPD? Why does this make sense?
A
FEV1 : FVC < 70%
COPD is an obstructive lung disease
24
Q
What does a FEV1 : FVC < 70% result indicate?
A
This means that the overall lung capacity is not as bad as the patient’s ability to quickly blow air out of their lungs
25
How can we use spirometry to differentiate between COPD and asthma? Why does this make sense?
We test the reversibility of airflow obstruction
This is due to the fact that COPD results in irreversible airflow obstruction, however asthma is reversible
26
How can we use spirometry to test airflow obstruction reversibility?
We administer bronchodilators or corticosteroids
27
What post-bronchodilator spirometry test result indicates COPD?
FEV : FVC < 70%
28
What spirometry results indicates stage one (mild) COPD?
Predicted FEV1 > 80%
Post-Bronchodilator FEV:FVC < 0.7
29
What spirometry result indicates stage two (moderate) COPD?
Predicted FEV1 = 50% – 79%
Post-Bronchodilator FEV:FVC < 0.7
30
What spirometry result indicates stage three (severe) COPD?
Predicted FEV1 = 30% - 49%
Post-Bronchodilator FEV:FVC < 0.7
31
What spirometry result indicates stage four (very severe) COPD?
Predicted FEV1 = < 30%
Post-Bronchodilator FEV:FVC < 0.7
32
What two investigations are used to diagnose COPD?
Clinical presentation
Spirometry
33
What are the three clinical criteria for a diagnosis of COPD?
> 35 years old
The patient presents with COPD clinical features
The patient presents with a COPD risk factor
34
What spirometry results indicate a diagnosis of COPD?
Spirometry = FEV : FVC < 70%
Post-bronchodilator spirometry = FEV : FVC < 70%
35
What two blood tests indicate a diagnosis of COPD?
Decreased Serum Alpha-1 Antitrypsin Levels
Decreased Transfer Factor for Carbon Monoxide (TLCO) Levels
36
What blood test can be used to differentiate between COPD and asthma? How?
TLCO
In COPD, TLCO levels are decreased, whereas in asthma they are increased
37
What additional blood test is conducted in COPD patients? Why?
FBC
To identify the development of secondary polycythaemia complications
38
What three ABG results indicate a diagnosis of COPD? Why does this make sense?
PaCO2 > 6
Bicarbonate > 30
pH < 7.35
These are signs of CO2 retention and respiratory acidosis
39
In what two ways are sputum cultures used to diagnose COPD?
They are used to identify chronic infections, such as pseudomonas
It enables targeted antibiotic therapy during COPD exacerbations
40
What are the four signs of COPD on CXRs?
Hyperinflation
Flattened Diaphragm
Hyperlucent Lungs
Bullae
41
How do we identify hyperinflation on CXRs?
The appearance of > 6 anterior ribs in the mid-clavicular line
OR
The appearance of > 10 posterior ribs in the mid-clavicular line
42
What is a bulla on CXR?
It is defined as an air space in the lung measuring > 1 cm in diameter in the distended state
43
What is another way in which CXRs are used to diagnose COPD?
They can be used to exclude lung cancer
44
How are ECG scans used to diagnose COPD?
They are used to identify the development of cor pulmonale complications
45
What are the two signs of cor pulmonale on ECG scans?
Peaked P waves
Right axis deviation
46
In what four ways do we conservatively manage COPD?
Smoking Cessation
Pulmonary Rehabilitation
Annual Influenza Vaccination
One Off Pneumococcal Vaccination
47
What is the most effective intervention to prevent progression of COPD disease?
Smoking cessation
48
What is step one of COPD pharmacological management?
It involves administration of a short acting bronchodilator
49
What are two subclassifications of short acting bronchodilators?
Short-Acting Beta2 Agonists (SABA)
OR
Short-Acting Muscarinic Antagonists (SAMA)
50
Name two SABAs examples
Salbutamol
Terbutaline
51
Name an example of SAMA
Ipratropium Bromide
52
What do we need to determine if step one of COPD pharmacological management fails?
Whether the patient has asthmatic/steroid responsiveness features
53
What are the four criteria used to determine whether an individual has asthmatic/steroid responsiveness features?
Previous Asthma/Atopic Disease
Increased Eosinophil Count
FEV1 Variation > 400ml
Diurnal PEF Variation > 20%
54
What is step two of COPD pharmacological management (in individuals with no asthmatic/steroid responsiveness features)?
Combined Long Acting Bronchodilator
55
What is contained within combined long acting bronchodilators?
Long-acting beta2 agonist (LABA)
Long-acting muscarinic antagonist (LAMA)
56
Name three examples of combined long acting bronchodilators
Anoro ellipta
Ultibro breezhaler
DuaKlir genuair
57
What is step two of COPD pharmacological management (in individuals with asthmatic/steroid responsiveness features)?
Combined LABA & ICS
58
Name three examples of combined LABA & ICS
Fostair
Symbicort
Seretide
59
In step two of COPD pharmacological management, what do we need to remember about step one?
All patients who were administered SAMA as their first line, need to be switched to SABA
60
What is step three of COPD pharmacological management?
It involves administration of triple therapy combination inhalers
61
What is contained in triple therapy combination inhalers?
LABA
LAMA
ICS
62
Name two examples of triple therapy combination inhalers
Trimbo
Trelergy ellipta
63
What three oral pharmacological options can be used to manage COPD?
Oral Theophylline
Oral Prophylactic Antibiotics
Oral Mucolytics
64
When is oral theophylline considered as a management option for COPD?
It is a fourth line management option, which should only be considered after trials of short/long acting bronchodilators or in those who are unable to administer inhaled therapy
65
What oral prophylactic antibody can be used to manage COPD?
Azithromycin
66
What are the three criteria for oral prophylactic antibiotic administration in COPD patients?
Non-Smokers
Optimised Standard Treatment
Recurrent Exacerbations
67
What oral mucolytic can be administered to manage COPD?
Carbocysteine
68
When do we consider oral mucolytics to manage COPD?
In those with a chronic productive cough
69
In which six circumstances do we conduct assessment for LTOT administration?
FEV1 < 30%
Cyanosis
Polycthaemia
Peripheral oedema
Raised JVP
O2 saturations < 92%
70
How do we assess whether patients should be administered LTOT?
ABG on two occasions, at least three weeks apart in patients with stable COPD on optimal management
71
What ABG result indicates the administration of LTOT?
In cases where patients have a pO2 < 7.3
OR
In cases where patients have a pO2 1.3 - 8, with one of the following complications; secondary polycythaemia, peripheral oedema, pulmonary hypertension
72
When is LTOT contraindicated? Why?
Smokers
Due to a risk of explosion/burns
73
What are the five complications of COPD?
Hypercapnic Respiratory Failure
Cor Pulmonale
Bronchiectasis
Secondary Polycythaemia
Osteoporosis
74
What is cor pulmonale?
It is right-sided heart failure due to chronic pulmonary hypertension
75
What type of pleural effusion is associated with cor pulmonale - exudate or transudate?
Transudate
76
When does cor pulmonale tend to arise in COPD?
End stage COPD
77
What complication of COPD is associated with increased TLCO levels?
Secondary polycythaemia
78
What is a COPD exacerbation?
It is defined as an acute deterioration of clinical features
79
What is the most common trigger of COPD exacerbations?
Respiratory tract infection
80
What are the four common infective agents that trigger COPD exacerbations?
Haemophilus influenzae
Streptococcus pneumoniae
Moraxella catarrhalis
RSV
81
What is the most common infective agent to trigger COPD exacerbations?
Haemophilus influenzae
82
What five investigations are used to diagnose a COPD exacerbation?
Blood Tests
Arterial Blood Gas (ABG)
Sputum Culture
Chest X-Ray (CXR)
ECG Scan
83
What are the three blood tests used to diagnose a COPD exacerbation?
Full Blood Count (Increased WCC Levels)
Blood Culture (Infective Agent)
Urea & Electrolytes (Deranged Results)
84
What three ABG results indicate a diagnosis of COPD exacerbation? Why does this make sense?
PaCO2 > 6
Bicarbonate > 30
pH < 7.35
These are signs of CO2 retention and respiratory acidosis
85
In what other way are ABGs used to diagnose a COPD exacerbation?
It is used to identify the development of respiratory failure complications
86
What are the two signs of type one respiratory failure on ABG?
Normal pCO2 levels
Decreased pO2 levels
87
How can we remember type one respiratory features on ABG?
Only ONE result is affected
88
What are the two signs of type two respiratory failure on ABG?
Decreased pCO2 levels
Decreased pO2 levels
89
How can we remember type two respiratory features on ABG?
TWO results are affected
90
How are sputum cultures used to diagnose COPD exacerbations?
It can be used to identify infections and enable targeted antibiotic therapy
91
How are CXRs used to diagnose COPD exacerbations?
They can be used to identify infections
92
How are ECG scans used to diagnose COPD exacerbations?
They are used to identify cor pulmonale complications
93
When is oxygen therapy used to manage COPD exacerbations?
When oxygen saturation levels are below 88%
94
What oxygen mask is used to deliver oxygen to COPD patients?
Venturi mask
95
What is a venturi mask?
They are masks used to deliver a specific percentage of oxygen
96
What oxygen saturation level is aimed for in COPD CO2 retainers?
88% - 92%
97
Why do we aim for lower oxygen saturation levels in COPD CO2 retainers?
CO2 retainers respiratory drive is dependent upon CO2 levels
Therefore if we administer these patients too much oxygen, there is decreased stimulation of their respiratory drive - leading to a decreased respiratory rate and increased retention of CO2
98
How can we identify CO2 retainers?
ABG - normal bicarbonate levels but increased pCO2 levels
99
What oxygen saturation level is aimed for in COPD non-CO2 retainers?
> 94%
100
When is non-invasive ventilation indicated for management of COPD exacerbations?
Respiratory acidosis persists despite immediate maximum standard medical treatment
PaCO2 > 6
pH < 7.35, > 7.26
101
What non-invasive ventilation is used to manage COPD exacerbations?
Bi-level positive airway pressure
102
What are the three pharmacological management options for COPD exacerbations in a primary care setting?
Short-Acting Bronchodilators
Prednisolone
Antibiotics
103
How do we review short acting bronchodilator administration during COPD exacerbations?
We administer them at an increased frequency
In some cases, individuals are administered a nebuliser
104
What prednisolone dose is administered to treat COPD exacerbations?
30mg once daily for a course of 5 - 14 days
105
What three antibiotics are administered to treat COPD exacerbations?
Amoxicillin
Clarithromycin
Doxycycline
106
When do we consider antibiotic administration in COPD exacerbations?
When individuals present with purulent sputum or clincial signs of pneumonia
107
What are the five pharmacological management options for COPD exacerbations in a secondary care setting?
Nebulised Bronchodilators
IV Bronchodilators
Steroids
Antibiotics
Analeptics
108
What two nebulised bronchodilators are administered to manage COPD exacerbations? At what dose?
Salbutamol 5mg/4h
Ipratropium bromide 500mcg/6h
109
What IV bronchodilator is administered to manage COPD exacerbations?
Aminophylline
110
When do we administer IV bronchodilators to manage COPD exacerbations?
In severe cases that don't respond to nebulised bronchodilators
111
What is the function of analeptics?
To stimulate the CNS
112
What analeptic is administered to manage COPD exacerbations?
Doxapram
113
When do we administer analeptics to manage COPD exacerbations?
In severe cases that don't respond to oxygen therapy
