COPD Flashcards Preview

PH2113 > COPD > Flashcards

Flashcards in COPD Deck (23):
1

What is COPD?

General term encompassing a number of diseases esp. chronic bronchitis and emphysema; non-reversible, progressive

2

Effects of chronic bronchitis

Lung damage and inflammation in airways
Cough with sputum production
Hyperplasia and hypertrophy of goblet cells and mucus glands
Scarring and remodelling of lung tissue >>> loss of elasticity
Hypoxia/ cyanosis resulting in blue tinge to lips and skin

3

Effects of emphysema

Lung damage and inflammation of alveoli
Enlargement of the air spaces distal to the terminal bronchioles
Reduced surface area and elasticity
Airways collapse
Effort for breathing results in a pink flush in the face

4

Prevalence of COPD

Approximately 1 million in England and Wales
Stable prevalence in men, increasing in women
1 in 8 acute admissions
30,000 direct deaths per year

5

Risk factors

Exposure to tobacco smoke, occupational dusts/ chemicals, indoor/ outdoor pollution, infections; host factors: alpha1 antitrypsin deficiency, airways hyper responsiveness, age/gender; socio-economic status

6

Associated co-morbidities

Weight loss, nutritional abnormalities, skeletal muscle dysfunction, MI, angina, osteoporosis, respiratory infection, sleep disorders, depression, diabetes, anaemia, glaucoma

7

A diagnosis of COPD should be considered in patients:

Over the age of 35, who have a risk factor (generally smoking), and who present with exertional breathlessness, chronic cough, regular sputum production, frequent winter bronchitis or wheeze

8

Possible investigations

Spirometry
History and examination
Chest x-ray
FBC
BMI

9

FEV1
FVC

Forced Expiratory Volume in 1 second
Forced Vital Capacity

10

Airflow obstruction is defined as:

A reduced FEV1 < 80% predicted
and a reduced FEV1/FVC ratio < 0.7

11

Reversibility testing

A large (>400mL) response to bronchodilators
A large (>400mL) response to 30mg oral prednisolone daily for 2 weeks
Serial peak flow measurements showing 20% or greater diurnal or day to day variability
Clinically significant COPD is not present if the FEV1 and FEV1/FVC ratio return to normal with drug therapy

12

Assessing disease severity using FEV1

Mild >80%
Moderate 50-80%
Severe 30-49%
Very severe <30%

13

Smoking cessation effects

Slows disease progression
Does not restore loss of lung function
Can be used as primary prevention
Sudden cessation better than gradual
Advice and behavioural modification useful
Important role for pharmacists with NRT

14

Pharmacological treatment of COPD

Inhaled bronchodilators, inhaled corticosteroids, oral corticosteroids, theophylline, combination therapy

15

Further treatment of COPD

Oxygen therapy, mucolytics, antidepressants, surgery, palliative care

16

Methods of pulmonary rehabilitation (non-pharmacological)

Disease education, exercise, dietary advice, psychological input

17

Long term oxygen therapy- when is appropriate

Very specific circumstances, improves survival, inappropriate oxygen therapy can cause respiratory depression, need therapy for 15-20 hours per day

18

Acute exacerbations of COPD presenting features

Increased wheeze, increased dyspnoea, increased sputum volume, increased sputum purulence, chest tightness, fluid retention

19

Causes of acute exacerbations

interaction between host factors, viruses, bacteria and changes in air quality causing increased inflammation in lower airways

20

Treatment methods for acute exacerbations

Add or increase bronchodilators, antibiotics, oral corticosteroids, oxygen

21

Antibiotics for use in acute exacerbations

Amoxycillin, ampicillin, tetracycline, macrolide

22

Oral corticosteroid dose

Prednisolone 30mg daily for 7-14 days, only prescribe in breathlessness, admission to hospital

23

What strength oxygen treatment is appropriate and why?

Always use low strength e.g. 24%
COPD patients become tolerant to prolonged CO2 retention and respiratory drive is maintained by low levels of O2, high strength O2 will cause respiratory arrest