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Chronic Obstructive Pulmonary Disorder (COPD) Flashcards

(44 cards)

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1
Q

Define COPD

A

Chronic, slowly progressive airflow obstruction with little to no reversibility or variability due to lung tissue damage, heavily associated with smoking

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2
Q

What are the causes of COPD?

A

Smoking

Alpha 1 Antitrypsin Deficiency

Jobs involving dust, vapours, fumes

Air pollution

Chronic asthma

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3
Q

Describe the presentation of COPD

A

Dyspnoea/Orthopnoea

  • Progressive and persistent

Cough

  • Clear sputum, persistent

Chest Tightness

Wheeze

Reduced chest expansion

Recurrent chest infection

Hyperinflated chest

Coraco-sternal distance <3cm

Resonant or hyper-resonant

Cyanosis

Tachypnoea

Use of accessory muscles

  • SCM, intercostals, abdominal muscles
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4
Q

What tests are used in the investigation/diagnosis of COPD?

A

ECG

  • Extended P waves due to atrial strain right sided heart failure

Sputum Culture

  • Infective causes of exacerbation

ABG

  • Evidence of type 2 respiratory distress
  • Acidosis

CXR

  • Hyperinflated chest (flattened hemidiaphragm, thin heart and increased number of visible anterior ribs)
  • Bullae

Alpha 1 Antitrypsin Test

FBC

  • Polycythaemia

Pulmonary Function Tests/Spirometry

  • Obstructive pattern

Transfer factor for CO

  • Decreased in COPD, can give an indication about the severity of the disease
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5
Q

What is the pharmacological management of stable COPD?

A

Short Acting Beta 2 Agonist (SABA)

Short Acting Muscarinic Antagonist (SAMA)

Long Acting Beta 2 Agonist (LABA)

Long Acting Muscarinic Antagonists (LAMA)

Inhaled Corticosteroids (ICS)

Long term oxygen therapy

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6
Q

Give an example of a SABA

A

Salbutamol

Terbutaline

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7
Q

Give an example of a SAMA

A

Ipatropium bromide

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8
Q

Give an example of an ICS

A

Beclometasone dipropionate

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9
Q

Give an example of a LAMA

A

Tiotropium

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10
Q

Give an example of a LABA

A

Salmetorol

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11
Q

Give an example of a LTRA

A

Montelukast

Theophylline

Aminothylline

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12
Q

What is the management of acute exacerbation of COPD? (emergency treatment)

A

High flow oxygen

Salbutamol nebulised 5mg/4h

IV 200mg Hydrocortisone

Intubation and ventillation in severe cases

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13
Q

What is the non-pharmacological managemet of COPD?

A

Smoking cessation

Pulmonary rehabilitation

  • Recomended early in diagnosis when patients begin to feel breathless

Vaccinations

  • Annual influenza
  • Once off pneumococcal
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14
Q

What are complications of long-term steroid use?

A

Immunosuppression

Bruising

>Abdominal fat

HTN

Osteoporosis

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15
Q

What is alpha-1-antitrypsin deficiency?

A

Lack of a1-antitrypsin, an enzyme made in the liver, that controls the breakdown of other enzymes in the body

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16
Q

What mode of inheritence is alpha-1-antitrypsin deficiency?

A

Autosomal recessive

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17
Q

How is alpha-1-antitrypsin deficiency managed?

A

Smoking cessation

Supportive

  • Bronchodilators
  • Physiotherapy

IV alpha1-antitrypsin protein concentrates

Surgery

  • Lung volume reduction surgery
  • Lung transplantation
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18
Q

What is a complication of alpha-1-antitrypsin deficiency?

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A

Hepatocellular carcinoma

19
Q

Why does COPD cause secondary polycythemia?

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A

Secondary polycythemia most often develops as a response to chronic hypoxemia, which triggers increased production of erythopoietin by the kidneys

20
Q

What is the diagnostic test for COPD?

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A

Spirometry, showing an obstructive pattern with little to no reversibility

21
Q

What organisms cause infective exacerbations of COPD?

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A

Haemophilus influenzae

Streptococcus pneumoniae

Moraxella Catarrhalis

Rhinovirus

22
Q

What is the most common organism causing infective exacerbations of COPD?

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A

Haemophilus influenzae

23
Q

Give features that suggest a patient’s COPD would be steroid responsive

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A

Previous diagnosis of asthma or atopy

>Eosinophil

Variation of FEV1

Variation of peak expiratory flow

24
Q

Describe the COPD management ladder in steroid responsive patients

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A

SABA/SAMA, stays throughout ladder

LABA and ICS

LABA, LAMA, ICS triple therapy

Specialist referral

25
Describe the COPD management ladder in a non steroid responsive patient
SABA/SAMA stays throughout ladder LABA + LAMA LABA LAMA + ICS triple therapy 3 month trial and reverted back if it does not work Specialist referral
26
When should long term oxygen therapy be offered?
If ABG show PaO2 \< 7.3kpa on two occassions measured 3 weeks apart Or to those with a pO2 of 7.3 - 8 kPa and one of the following * secondary polycythaemia * peripheral oedema * pulmonary hypertension
27
What interventions improve survival in COPD?
Smoking cessation Long term oxygen therapy
28
What antibiotic is used for infection prophylaxis in COPD?
Azithromycin Doxyclycline if long QT syndrome
29
What has to be monitored with azithromycin use?
ECG * Can cause long QT syndrome LFTs
30
What factors would prompt the assessment of a patient for long term oxygen therapy?
FEV1 \<30-49% Cyanosis Polycythaemia Peripheral oedema \>JVP O2 \<92% on room air Do not offer LTOT to people who continue to smoke despite being offered smoking cessation advice and treatment, and referral to specialist stop smoking services
31
What feature of COPD can mimic a pneumothorax?
Large bullae
32
What should be given in patients with frequent exacerbations of COPD?
Home supply of prednisolone and azithromycin
33
What is a complication of oxygen administration in COPD patients?
Over administration of oxygen These patients lose their hypoxic drive for respiration, therefore retain CO2 and subsequently hypoventilate leading to respiratory arrest/type 2 respiratory failure
34
What is the O2 sat goals in COPD patients?
88-92% target until blood gases available 94-98% if CO2 is normal on ABG
35
Describe an obstructive spriometry pattern
decreased FEV1 normal/decreased FVC decreased FEV1/FVC
36
What is FEV1?
Forced expiratory volume The amount of air a person can forcefully exhale in one second
37
What is FVC?
Forced vital capacity The amout of air a person can forcefully exhale after taking a deep breath
38
What is the FVC/FEV1 ratio in COPD?
Less than 0.7 Meaning that being able to blow air out is limited by the damage to their airways causing airway obstruction
39
What should be offered to pregant woman who smoke?
Nicotine replacement therapy should be offered, varenicline and bupropion are contraindicated
40
What is stage 1/mild airflow obstruction?
FEV1 over 80% of predicted
41
What is stage 2/moderate airway obstruction?
FEV1 50-79% of predicted
42
What is stage 3/severe airway obstruction?
FEV1 30-49% of predicted
43
What is stage 4/very severe airway obstruction?
FEV1 less than 30% of predicted
44
What oxygen should be used to treat any critically ill patient?
High flow/15l via non re-breather mask **EVEN IN CO2 RETAINERS/COPD**

Respiratory (14 decks)

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