CLINICAL- COPD Flashcards Preview

FINAL YEAR PHARMACY > CLINICAL- COPD > Flashcards

Flashcards in CLINICAL- COPD Deck (37):
1

What is the main cause of COPD? How many pack years?

Smoking!

Need to smoke 20 cigarettes a day (1 pack) for 20 years: 1 x 20= 20 pack years

2

What are the typical clinical features of COPD?

Exertional Dyspnoea (posh term for breathlessness/ SOB)
Cough (chronic productive cough)
Sputum production (mucus cough ups)
Wheeze

3

Do the symptoms of COPD come and go?

No. This is a key difference to asthma.
The symptoms of COPD are Fixed, there all the time, the disease course is progressive.

Asthma: symptoms come and go: can be no symptoms until something triggers it

4

What is the key diagnostic tool we use to diagnose COPD?

Spirometry
Take a deep breath out into a machine
From this we can get the FEV1 (forced expiratory volume in 1 second) and FVC (Forced vital Capacity)
There is two types of defects: obstructive defect, restrictive defect

5

What is the obstructive defect seen in Spirometry?

Where FEV1/ FVC ratio is UNDER 70%

This would show it's COPD or asthma as opposed to Restrictive Defect

6

What is the restrictive defect seen in spirometry??

Where both FEV1 and FVC are down

The FEV1/ FVC is normal or over 70% (under 70% with obstructive defect in COPD asthma)

Restrictive defect indicates LUNG FIBROSIS

7

Can you think of further complications COPD may lead to?

Abnormal BMI: patients are breathless and so have exercise limitations so may have a high BMI. Or could have a low BMI if they're ill: may need nutritional supplements.

Anxiety and depression: especially in those most physically disabled.

Cor pulmonale: Pulmonary heart disease: enlargement and failure of the right side of the heart as a result of vascular resistance or high BP in the lungs. Patient may need oxygen and diuretics for this.

8

What two things can improve a COPD patients survival?

Oxygen (long term oxygen therapy)

Smoking cessation: can increase how long the COPD patient lives by stopping at any age- it's never too late!

(Note: all the drugs used in COPD are for symptom control not to improve survival!)

9

Breathlessness and exercise limitation can be extremely distressing for COPD patients as it can really effect their day to day lives. What to patients find especially difficult?

Climbing stairs.
Can be very scary for patient as they get very out of breath.

The symptom we ideally want to control is patients breathlessness.

10

What short acting inhalers can we use In COPD to control symptoms of SOB?

Short acting bronchodilators;

Short acting Beta 2 agonists (SABAs): salbutamol, terbutaline

Short acting Muscarinic antagonist (SAMAs: Not seen in asthma) e.g. Ipratropium, atrovent

Use these as required to alleviate symptoms

11

What long acting inhalers can we use in COPD to control the Shortness of breath symptom?

Long acting bronchodilators:
Long acting Beta2 Agonists (e.g. Serevent, eformeterol, salmeterol, Formeterol)

Long acting Muscarinic antagonists (e.g. Tiotropium, glycopyronnium)

12

What combination inhalers can we use in COPD?

Inhaled corticosteroids (ICS) combined with a LABA

E.g. Seretide (fluticasone propionate ICS combined with salmeterol LABA)

Symbicort: Budesonide (ICS) combined with Formeterol (LABA)

We can add in an ICS if their FEV1 is below 50% and they've have 2 or more exacerbations in the past 12 months

13

What's the vicious circle experienced by COPD patients??

They feel breathless ---> they avoid any activities that make them feel breathless----> they end up being less active---> their muscles become weaker and less efficient----> they get more breathless

They need to do more exercise but they feel they can't... This is where pulmonary rehabilitation comes in..

14

What is pulmonary rehabilitation??

Mostly patients with COPD that attend
Patient education
Exercise training
Psychosocial support
Advice on nutrition

15

After a patient with COPD has an exacerbation that causes a hospital admission, what is the chance of re-admission?

Around 40%

After a patients first severe COPD exacerbation they usually have them more frequent exacerbations to follow

16

How can we reduce frequent COPD exacerbations?

Can give pneumococcal and annual INFLUENZA VACCINES to prevent chest infections that would complicate COPD

Can optimise bronchodilator therapy with one or more Long acting bronchodilators (LABA, LAMA: e.g. Serevent and tiotropium)

We can add in an ICS if their FEV1 is below 50% and they've have 2 or more exacerbation in the past 12 months

17

What criteria has to be met in order to add an Inhaled corticosteroid (ICS) into a COPD patients treatment?

We can add in an ICS if their FEV1 is below 50% and they've have 2 or more exacerbations in the past 12 months

Have to meet both!!

18

What vaccines can be given to complications in frequent exacerbations?

Pneumococcal and annual influenza vaccines

This is to prevent infections as this would exacerbate and complicate COPD

19

What is Spiriva?

A LAMA: contains tioptropium

Used in preventing frequent exacerbations

20

What was the primary objective of the TORCH trial?

Looking at the effect of the seretide 500 accuhaler vs a control group on mortality over 3 years in patients with moderate to severe COPD

Basically looking at whether using seretide (an ICS combined with a LABA) will decreased the number of deaths from COPD in 3 years

21

What did the TORCH trial find?

They found that using seretide inhalers (combo of ICS and LABA) did reduce the risk of mortality and improved/ maintained health status over 3 years

Also improved lung function and reduced exacerbations requiring oral corticosteroids over 3 years

22

What was the primary objective of the UPLIFT trial?

To assess whether tiotropium 18ug once daily is associated with a decrease in the rate of decline of FEV1 over time in patients with COPD

They also looked at the effects of tiotropium combined with a LABA/ ICS

23

What did they find in the Uplift trial (the effect of using tiotropium vs a control group)?

There was a 14% reduction in risk in COPD exacerbations in those using tiotropium vs the control group

There was also sustained improvements in Quality of Life over 4 years

24

What is triple therapy in COPD?

Last stage of treatment after patients have remained symptomatic following Previous therapy.
It involves using a LABA combined with a ICS in a single inhaler (e.g. Symbicort) plus a LAMA

25

When should theophylline or aminophylline be used in COPD?

If COPD symptoms persist after the use of all stages of the inhaler treatment pathway including triple therapy
Or if patients are unable to use an inhaler

These are oral modified release tablets

Aminophylline may also be given IV in exacerbations is the patient doesn't respond to bronchodilators delivered through a nebuliser mask.

26

What can be given to patients with a chronic productive cough?

Mucolytics can be trialled, these reduce the viscosity of sputum

Eg. CARBOCISTEINE
ERDOSTEINE

27

How should anxiety and depression be treated in COPD?

According to normal guidelines
E.g. SSRI first line for depression etc

Just make sure you're always aware that COPD patients can suffer from this

28

What should we do if the patients sputum becomes more purulent than usual in an exacerbation?

Give them oral antibiotics

Purulent means containing pus
This would indicate infection

29

How do we manage exacerbations?

Bronchodilators increased and given through a nebuliser if necessary with oxygen if needed.

Give IV aminophylline if response to nedulised bronchodilators is poor

A short course of oral corticosteroid: PREDNISOLONE should be given (30mg daily for 7-14 days) if increased breathlessness interferes with daily activities (says in BNF)

Also consider oral antibiotics if sputum is purulent

30

In COPD patients with an episode of hypercapnic respiratory failure, They are usually give oxygen of a concentration of 24-28%. This is fairly low concentration (e.g. When compared to asthma) why is this?

COPD patients have a consistently high level of CO2.

As CO2 is always High, the low levels of oxygen become the respiratory driver.

So if we suddenly give them high concentrations of oxygen: there's a risk of reducing their respiratory drive and they stop breathing

So never give high concentrations of oxygen in COPD patients!!

31

A holistic approach is taken to managing COPD
Different things work for different people that's why there is different options.

Before rushing into adding drugs or changing drugs:
Make sure you've done the simple things like smoking cessation and checking inhaler technique!
It's never too late for smoking cessation

32

What two conditions does COPD (chronic obstructive pulmonary disease) cover?

Chronic bronchitis (airway inflammation and increased mucus)

Emphysema (alveolar air space destruction and enlargement)

33

What are the newer LAMAs now licensed for maintenance treatment in COPD patients?

Aclidinum (an inhalation powder)

Glycopyrronium (inhalation powder that comes in dry powder capsules)

34

The new Seebri Breezhaler, containing LAMA glycopyrronium, is now licensed as a new maintenance treatment in COPD. How long till you have to dispose of each inhaler?

Dispose after 30 days of use

35

What is Roflumilast?

Can be used as an add-on to bronchodilator treatment in adults with severe COPD associated with chronic bronchitis with a history of frequent exacerbations

36

What is the index used to assess the severity of COPD?

BODE index:

BMI
Obstruction
Dysponea
Exercise

37

We can score severity of COPD in patients using their FEV1 values. MILD is seen as FEV1 over 80%
Very severe us under 30%
What is moderate and severe?

Moderate: FEV1= 50-79%
Severe: FEV1= 30-49%