COPD Flashcards Preview

Hugh's MD2 Core Conditions and Presentations > COPD > Flashcards

Flashcards in COPD Deck (25):
1

What are the causes of exacerbations of COPD?

Infective (doesn't include pneumonia)

HF

PE

2

What are some physical signs of COPD?

Hyperresonance to purcussion

Barrel chest

Dull breath sounds

 

3

Define COPD

A progressive condition of irreversible airflow limitation due to an ongoing, abnormal inflammatory response to noxious stimuli

4

Describe the epidemiology of COPD

3rd leading cause of disease burden in Aus

500,000 Australians have moderate COPD

5

Describe 4 microscopic aspects of the COPD pathophysiology

Destruction of alveolar septa

Loss of elasticity

Inflammatory cell infiltrate - Neutrophils, macrophages, CD8+

Destruction of pulmonary capillary bed

6

How do you make the diagnosis of COPD?

Spirometry

(RFT)

7

By what factor is FER reduced for COPD to be diagnosed?

70%

(FER = FEV1 / FVC)

8

Why might FVC be low in COPD lungs?

Gas trapping

9

What is chronic bronchitis?

Inhalation of a noxious stimulus that causes production of mucus chronically

10

In which airways does inflammation generally occur? What is the consequence?

Peripheral

Fibrosis and obliterative bronchiolitis

11

What are some long acting beta2 agonists used in COPD?

Salmeterol

Eformaterol

Indacaterol (ultra long acting)

12

Name some anticholinergics used in COPD?

Tiotropium (spiriva)

Ipratropium (atrovent)

13

What is the mechanism of action of tiotropium (spiriva)

It's an anticholinergic - Blocks M3 muscarinic receptors on smooth muscle cells and submucosal glands to reduce bronchocontriction and mucus secretion

14

What are some side effects of anticholinergics?

Dry mouth

15

When are inhaled corticosteroids indicated in COPD?

GOLD Criteria Stage III and IV

(III - FEV1 = 30-50% predicted)

Incombination with LABA

16

What is seratide a combination of?

Salmeterol and fluticasone

17

What is pulmonary rehabilitation?

Patients develop mastery of their airways

18

What is the benefit of oxygen home therapy?

Improves mortality

Reduces pulmonary hypertension

19

Why does lung reduction surgery help in COPD?

Bad lung impinges on good lung

20

What therapies can be used in exacerbations?

O2

Antibiotics

Bronchodilators

Corticosteroids

Physical activity

Non-invasive ventilation

21

How do you approach the Ix and Mx of IECOPD?

Ix

- FBE, UEC

- CXR

- Blood culture

- ABG

 

Management

- O2, aim sats 88-92% (if CO2 retainer)

- Bronchodilators - Salbutamol, up to 12 puffs prn, Ipatropium up to 5 buffs

- Steroids - Pred ~50mg, 3d

- Antibiotics - oral doxycycline/amoxicillin

22

Clinically, what defines an exacerbation of COPD?

Change in cough

Change in character of sputum

Increase in dyspnoea

23

What is the casade of treatment for COPD

Gold 1 (FEV1 >80%) Short acting beta-agonist

Gold 2 (50-80%) SABA and LAMA

Gold 3 (30-50%) SABA, LAMA, consider inhaled corticoid steroid/LABA

Gold 4 (<30) Consider Oral steroids, Home O2, and Surgical reduction of the lung

24

How is chronic bronchitis diagnosed?

Chronic cough for most days of the weeks for 3 months of the a year

25

What does COPDX stand for?

Confirm diagnosis

Optimise lung function

Prevent decline

Develop support network

X - prevent exacerbations