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COPD Flashcards

1
Q

What is COPD?

A

Non-reversible, long term deterioration in air flow through the lungs caused by damage to lung tissue

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2
Q

What are the two forms of COPD?

A
  • Chronic bronchitis
  • Emphysema
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3
Q

What does the damage to the lung tissue result in?

A

An obstruction to the flow of air through the airways making it more difficult to ventilate the lungs and making them prone to developing infections

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4
Q

What is the main cause of COPD?

A

Smoking

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5
Q

What is the typical presentation of COPD?

A
  • cough: often productive
  • dyspnoea
  • wheeze
  • Long term history of smoking
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6
Q

What are the main investigations for COPD?

A

Full blood count
BMI
Spirometry
Chest X-ray

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7
Q

What would you look for in a full blood of someone with suspected COPD?

A

Polycythaemia (too many RBC) or anaemia

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8
Q

What does polycythaemia a response to?

A

Chronic hypoxia

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9
Q

What might you see on a chest x-ray of someone with COPD?

A
  • hyperinflation
  • bullae
  • flat hemidiaphragm
  • lack of lung markings
  • large central pulmonary arteries
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10
Q

What would postbronchodilator spirometry be in someone with COPD?

A

FEV1:FVC <70%

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11
Q

What is the diagnosis of COPD based on?

A

Clinical history and spirometry

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12
Q

What is the severity of COPD based of?

A

FEV1

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13
Q

What is stage 1 COPD?

A

FEV1 >80% predicted
Mild symptoms of COPD present

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14
Q

What is stage 2 COPD?

A

FEV1 50-79% predicted
Moderate

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15
Q

What is stage 3 COPD?

A

FEV1 30-49% predicted
Severe

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16
Q

What is stage 4 COPD?

A

FEV1 <30% predicted
Very severe

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17
Q

What is the general management of COPD?

A

smoking cessation advice
annual influenza vaccination
one-off pneumococcal vaccination
pulmonary rehabilitation

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18
Q

What is the first line management of COPD?

A

Bronchodilator therapy

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19
Q

What are the first line bronchodilators?

A
  • short-acting beta2-agonist (SABA) or
  • short-acting muscarinic antagonist (SAMA)-
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20
Q

What are examples of SABA inhalers?

A

Salbutamol
Terbutaline

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21
Q

What are examples of SAMA inhalers?

A

Ipratropium bromide

22
Q

For patients who remain breathless or have exacerbations despite using short-acting bronchodilators, what is the next step dependent on?

A

Asthmatic features/features suggesting steroid responsiveness
No asthmatic features/features suggesting steroid responsiveness

23
Q

What is the next step in the management of a patient with NO asthmatic features/features suggesting steroid responsiveness?

A

Add a long-acting beta2-agonist (LABA) + long-acting muscarinic antagonist (LAMA

24
Q

What is the next step in the management of a patient with asthmatic features/features suggesting steroid responsiveness?

A

LABA + inhaled corticosteroid (ICS)

25
What is the management of a patient if they remain breathless or have exacerbations?
Offer triple therapy
26
What is triple therapy?
LAMA + LABA + ICS
27
What should you switch a SAMA to when adding a LAMA/LABA?
Switch to a SABA
28
When should oral theophylline be tried for someone with COPD?
Only after trying short and long-acting bronchodilators or for those who cannot used inhaled therapy
29
What oral antibiotic prophylactics could you give to someone with COPD?
Azithromycin
30
When might mucolytics be considered in a patient with COPD?
In patients with a chronic productive cough
31
When might long term oxygen therapy be considered?
* very severe airflow obstruction * cyanosis * polycythaemia * peripheral oedema * raised jugular venous pressure * oxygen saturations less than or equal to 92% on room air
32
What level of airflow obstruction would indicate long term oxygen therapy?
FEV1 < 30% predicted
33
Who should long term oxygen therapy not be offered to?
people who smoke
34
What is emphysema?
Abnormal irreversible enlargement of the airspaces distal to the terminal bronchioles Reduces the alveolar surface area thus impeding efficient gaseous exchange.
35
What is chronic bronchitis?
Chronic exposure to noxious particles causes hypersecretion of mucus in the large and small bronchi. Airway inflammation and fibrotic changes result in narrowing of the airways and subsequently chronic airway obstruction.
36
What would suggest asthmatic features that would respond to steroids?
PMH of atopy or asthma Eosinophilia substantial variation in FEV1 over time (at least 400 ml) Substantial diurnal variation in peak expiratory flow (20%)
37
What is the main cause of chronic bronchitis?
Smoking
38
What are the possible causes of emphysema?
Smoking Alpha-1 antitrypsin
39
What are the requirements for long term antibiotic prophylaxis for COPD?
Patients should not smoke Should have optimised standard treatments and continue to have exacerbations
40
What needs to be done before azaithromycin can be prescribed?
ECG to exclude QT prolongation should also be done as azithromycin can prolong the QT interval
41
What does a deficienct of Serum alpha-1 antitrypsin deficiency lead to?
Early onset and more severe disease
42
What would you find on -Pulse oximetry and ABG/VBG of someone with COPD?
↓PaCO2, hypercapnia
43
What is hypercapnia?
Presence of higher than normal level of carbon dioxide in the blood
44
What would you see on a CT thorax of someone with COPD?
Bronchial wall thickening Scarring
45
What will the post-bronchodilator spirometry always stay at in someone with COPD?
It will always be <0.7
46
What might you see on an ECG and echo of someone with COPD?
Right atrial and ventricular hypertrophy
47
Why would you do a sputum culture in someone with COPD?
To check for infection
48
What are the features of Cor pulmonale in COPD?
Peripheral oedema Raised jugular venous pressure Systolic parasternal heave Loud P2
49
What can be used in the management of cor pulmonale in COPD?
Loop diuretic for oedema, Consider long-term oxygen therapy
50
What can be used to improve surivival in someone with COPD?
smoking cessation long term oxygen therapy lung volume reduction surgery
51
When would LTOT be offered for someone with COPD?
2 result of pH <7.3 or Those with a pO2 of 7.3 - 8 kPa and one of the following: --secondary polycythaemia --peripheral oedema --pulmonary hypertension

Respiratory (47 decks)

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