COPD Flashcards
how is COPD characterised?
life threatening lung disease
– Chronic
– Characterised by airflow obstruction
– Associated with an abnormal inflammatory response
– Not fully reversible
– Progressive i.e. worsens over time
define COPD
Characterised by airflow obstruction. The airflow obstruction is usually progressive, not fully reversible, and does not change markedly over several months.
Obstruction is due to a combination of airway and parenchymal damage. The damage is the result of chronic inflammation that differs from that seen in
asthma, and is usually the result of smoking.
who is COPD most common in?
65+
when is COPD slightly reversible?
when there is an element of asthma
can you get COPD if you never smoked?
yes- 12.2% have never smoked
what are the signs and symptoms of COPD?
- Exertional breathlessness
- Chronic cough
- Regular sputum production
- Frequent winter ‘bronchitis’
- Wheeze
- Chest tightness
- Fatigue
what are the possible complications of COPD?
- Cor pulmonale/heart failure
- Respiratory failure
- Sleep apnoea syndrome –prolonged
pauses in breath whilst asleep - Repeated respiratory infections particularly in the winter
- Osteoporosis
who do you consider a disgnosis of COPD with?
– Over 35 and
– Smokers or ex-smokers
– Have any of the symptoms
* Exertional breathlessness
* Chronic cough
* Regular sputum production
* Frequent winter bronchitis
* Wheeze
how would you diagnose someone without clinical symptoms of asthma?
– Chronic unproductive cough
– Significant variability in breathlessness
– Night time symptoms
– Significant diurnal or day to day variability in symptoms
what should a patient be asked about if COPD diagnosis should be considered?
– weight loss
– effort intolerance
– waking at night
– ankle swelling
– fatigue
– occupational hazards
– chest pain
– haemoptysis.
when do you preform a spirometry?
– at diagnosis
– to reconsider the diagnosis, for people who show an
exceptionally good response to treatment
– to monitor disease progression.
how do you confirm the diagnosis of COPD with spirometry
Measure post-bronchodilator spirometry to confirm the
diagnosis of COPD.
when s=would you think about alternative diagnosis in spirometry?
older people who have an FEV1/FVC ratio below 0.7 but do not have typical symptoms of COPD.
what would show a restrictive effect in spirometry?
– FVC is reduced and the FEV1/FVC ratio is >80%
– The lung volume is reduced and the FEV1 and FVC are reduced proportionately
when would spirometry show an obstructive effect?
Obstructive effect (e.g. asthma or COPD)
– FEV1 is reduced more than the FVC and the FEV1/FVC ratio is <80%
– FEV1 is less than 80% of predicted
– FVC can be near predicted
what additional investigations should be done at the time of initial diagnostic evaluation?
a chest radiograph to exclude other
pathologies
– a full blood count to identify anaemia or
polycythaemia
– BMI calculated.
what are the different measures on the dyspnoea scale?
1 Not troubled by breathlessness except on strenuous exercise
2 Short of breath when hurrying or walking up a slight hill
3 Walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace
4 Stops for breath after walking about 100m or after a few minutes on level ground
5 Too breathless to leave the house, or breathless when dressing or undressing
what are the aims of COPD management?
prevent symptoms and their recurrence
– Slow the progression of the disease
– Preserve optimal lung function (short and long term)
– Enhance quality of life
what advice is given to COPD patients?
– stop smoking
– comply with medication
– take regular exercise/pulmonary rehabilitation
– attend for a regular influenza vaccination, and
a (once-only) pneumococcal vaccination
what is offered in smoking cessation?
– NRT
– Varenicline
– Bupropion
what pharmacological management is there for COPD?
- Bronchodilators
– Beta2 receptor agonists, antimuscarinic
agents, theophylline - Corticosteroids
- Oxygen therapy
when would you consider neubuisers?
for people with distressing
or disabling breathlessness despite maximal therapy using inhalers.
when should you not continue nebulising therapy?
reduction in symptoms
– an increase in the ability to undertake activities of daily living
– an increase in exercise capacity
– an improvement in lung function
why is long term use of oral corticosteroids not recommended for patients with COPD?
side effects
* Monitor people who are having long-term oral corticosteroid therapy for osteoporosis, and give them appropriate prophylaxis. Start prophylaxis without monitoring for people over 65.
