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Flashcards in COPD Deck (14):
1

what is COPD split into

chronic bronchitis and emphysema

2

what is chronic bronchitis

chronic irritation, defensive increase in mucus production and epithelial cell numbers (especially mucus glands)
non-reversible obstruction (some may have reversible asthmatic component)

3

what is emphysema

tissue destruction in the alveoli leading to loss in alveolar walls and increase in size of airspaces distal to terminal bronchiole (without fibrosis)

4

what causes it

smoking
passive smoking
fumes
dust

5

what are symptoms

develop over number of years
increasing breathlessness
persistent cough with sputum
frequent exacerbations
wheezing
weight loss
malaise
swollen ankles
increased infection risk

6

how is it diagnosed

spirometry - decrease in PERF, FEV1, FVC and TLCO
FEV1/FVC <75%
FEV1 response to B2 <15%
CXR - lung infiltrates if infection
Blood test - rule out other cause
Sputum culture - grow organism causing exacerbation

7

1st line treatment

SABA (salbutamol)
or SAMA (ipratropium)

8

2nd line treatment (if FEV1>50%)

LABA (salmeterol)
or LAMA (tiotropium) and discontinue SAMA

9

3rd line treatment (if FEV1<50%)

LABA (salmeterol) plus ICS (becomethasone, budesonide, prednisolone)
or LAMA (tiotropium) and discontinue SAMA

10

4th line treatment

LAMA (tiotropium) plus LABA (salmeterol) plus ICS

11

5th line treatment

if patient has 2 or more exacerbations in 12 months despite triple therapy, PD4 receptor antagonist (roflumilast) used

12

what is used in acute exacerbation

oral corticosteroids (prednisolone) and antibiotics

13

1st line antibiotics?

doxycycline / amoxicillin

14

2nd line antibiotics?

clarithromycin, moxifloxacin, (AND IV aminophylline (methylxanthine))