COPD Flashcards
(20 cards)
What is COPD
non-reversible airway obstruction with a combination of
- chronic bronchitis: excess mucus secretion in bronchial tree
- emphysema: increase in air spaces + destruction of alveolar walls
most commonly due to smoking
symptoms of COPD
productive cough
SOB
wheeze
recurrent respiratory infections
spirometry results in COPD
obstructive pattern with FEV1/FCV ratio < 70%
features of COPD that may be seen on CXR
hyperinflation
bullae
flat hemidiaphragm
loss of lung markings due to emphysema
what are the 5 grades of breathlessness
grade 1 = breathless with strenuous exercise
grade 2 = breathless walking uphilll
grade 3 = breathlessness on flat
grade 4 = stop to catch breath after 100m on flat
grade 5 = unable to leave house due to breathlessness
how is the severity of COPD classified
% of FEV1 predicted mild: >80% + symptoms must be present mod: 50-79% sev: 30-49% very severe: < 30%
what is the best thing COPD patients can do to slow disease progression
STOP SMOKING
which vaccines should COPD patients get
annual influenza
one of pneumococcal
first line management of COPD
SABA - Salbutamol or SAMA - ipratropium
2nd line therapy if persistent SOB in patients with no asthmatic or steroid responsiveness features
LAMA + LABA (tiotropium + salmeterol) combined inhalers: - Anoro Ellipta - ultibro breezhaler - Duaklir Genuair
asthmatic features / steroid responsiveness features in COPD
previous diagnosis of asthma / atopy
eosinophilia
FEV1 / Peak flow variability
2nd line therapy if persistent SOB in patient with asthmatic or steroid responsiveness features
LABA + ICS combined inhalers: - Seretide ( salmeterol + beclometasone) - Symbicort (formoterol + budesonide) - Fostair
3rd line therapy if persistent SOB in patient with asthmatic or steroid responsiveness features
LABA + ICS + LAMA triple therapy
combined inhalers:
- Trimbo
- Trelegy Ellipta
additional options in severe COPD
oral theophylline
oral mucolystic - carbocisteine
oxygen if hypoxia / cyanosis / polycythemia
prophylactic antibiotics - azithromycin
most common cause of infective exacerbations of COPD
Haemophilus Influenzae
what type of blood gas is seen in COPD
resp acidosis
- patient retaining CO2
02 sats aim in COPD patient
how is oxygen delivered
88-92%
venturi mask
management of acute exacerbation COPD
increase bronchodilator use
- salbutamol + ipratropium nebuliser in hospital / to be considered at home
prednisone 30mg for 7-14 days
antibiotics if purulent sputum / signs of pneumonia – amoxicillin 1st line
what underlying condition should be considered in early onset COPD
alpha 1 antitrypsin deficiency
what is the function of alpha 1 antitrypsin in the lung
maintains lung elasticity
- deficiency leads to emphysema
