COPD Flashcards
Explain the steps of using a metered dose inhaler
Remove the caps from the inhaler and
the spacer
* Shake the inhaler well
* Insert the mouthpiece of the metered
dose inhaler into the back of the spacer
* Insert the mouthpiece of the spacer into
the mouth and close the lips around the
mouthpiece. Avoid covering any small
exhalation holes
* Press down the canister of the metered
dose inhaler once to release one puff into
the spacer
* Immediately take 3–4 slow deep breaths
* Repeat steps 4–6 for each puff
prescribed, waiting at least 30 seconds
between puffs
* Rinse mouth after inhalation of
corticosteroid
What is the difference between asthma and COPD (5)
Asthma:
Young age onset, usually < 20 years.
* History of hay fever, eczema and/or allergies.
* Family history of asthma.
* Symptoms are intermittent with periods of normal breathing in between.
* Symptoms are usually worse at night or in the early hours of the morning, during an upper respiratory tract infection, when
the weather changes, or when upset.
- Marked improvement with beta2 agonist.
COPD
Older age onset, usually > 40 years.
* Symptoms slowly worsen over a long period of time.
* Long history of daily or frequent cough before the onset of shortness of breath.
* Symptoms are persistent rather than only at night or during the early morning.
* History of heavy smoking (> 20
cigarettes/day for ≥15 years), heavy cannabis use, or previous TB.
Little improvement with beta2 agonist.
Explain what COPD is
Abnormal inflammatory response of the lungs to irritants & gases with
progressive reduction in airflow
Differentiate between emphysema and bronchitis
Emphysema: incurable lung disease where alveoli fill up with air, lung surface is gradually reduced & breathing difficulty
* Chronic bronchitis: Inflammation of lining of bronchial tubes, which carry air to and from lungs
What are the causes of COPD?
Causes: related to chronic irritation of the lungs caused by cigarette smoking > 10 yrs, marijuana smoking, Post-tuberculosis, inhalation of
fossil fuels, mining: dust exposure & pollutants
Symptoms of COPD
Symptoms
* chronic cough with/without sputum production on most days for 3 or more months for 2 or more consecutive years
* Dyspnoea / shortness of breath
* Wheezing
The onset is very gradual with progressively worsening symptoms. Due to
the large reserve capacity of the lungs, patients often present when there is
considerable permanent damage to the lungs.
* Manifestations of right-sided heart failure
* Acute bronchitis after a cold / flu
General measures for chronic bronchitis:
Smoking cessation, including cannabis (dagga), is the mainstay of
therapy.
* Chest physiotherapy where available.
* Exercise.
COPD medicine Tx step 1
SABA
* Salbutamol, inhalation, 3–4 times daily as needed for relief of
wheeze
Step 2 of COPD tx
If not controlled on SABA alone and diagnosis was confirmed by
spirometry (with < 2 exacerbations per year): ADD
* Long-acting β2-agonist (LABA), e.g.:
* Formoterol, inhaled 12 hourly.
OR
If not controlled on SABA alone and spirometry not available:
* Inhaled LABA/corticosteroid combination e.g.:
* Salmeterol/fluticasone, inhalation, 12 hourly.
COPD Tx step 3 (If not controlled on a LABA alone or frequent exacerbations (≥ 2 per
year):
Inhaled LABA/corticosteroid combination e.g.:
* Salmeterol/fluticasone, inhalation, 12 hourly
What’s important to note about fluticasone and budosenide?
interacts with protease inhibitors.
What to do if not controlled on step 3?
If not controlled on step 3: ADD
* Theophylline, slow release, oral at night, stop of no benefit after 12 months
Symptoms that occur in acute exarcebations
wheeze
* breathlessness
* tightness of the chest
* respiratory distress
* cough
- Bronchospasm is partially reversible with COPD
Medical management of acute exarcebations
Oral corticosteroids:
Prednisone, oral, 30mg daily for 5 days
Note: Oral corticosteroids may be required for acute exacerbations, but these have severe long-term complications and should only be used long-term if benefit has been proven by lung function testing.
What s the Mx of Acute infective exacerbation of chronic bronchitis:
Amoxicillin, oral, for 5 days.
Severe penicillin allergy:
* Doxycycline, oral, for 5 days.
