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General Practice YR3 > COPD pre work (+asthma) > Flashcards

COPD pre work (+asthma) Flashcards

1
Q

COPD pathophys

A
  • Treatable (not curable)
  • Largely preventable
  • Perisstent resp symptoms- breathlessness, cough, sputum
  • Airflow obstruction
  • Progressive, not fully reversible
  • Chronic inflam - usually caused by exposure to tobacco spoke (can also be envitonment and occupational)
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2
Q

Symptoms to suspect COPD

A
  • Breathlessness - progressive, persistent, worse on exertion
  • Wheeze
  • Chronic/recurrent cough
  • Regular sputum
  • Freq LRTI

Can get:
* Weight loss, anorexia, fatigue
* Waking at night due to breathlessness
* Ankle swelling
* Chest pain
* Haemoptysis
* Reduced exercise tolerance

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3
Q

Examination signs of COPD

A
  • Cyanosis
  • Raised JVP +/- peripheral oedema - cor pulmonale?
  • Cachexia
  • Hyperinflation of chest
  • Use of accessory muscles +/- pursed lips breathing
  • Wheeze +/- crackles on ausc
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4
Q

RF for COPD

A
  • Smoking
  • Occupational/environmental exposures - dusts, fumes/chemicals
  • Air pollution
  • Genetics - alpha 1 antitrypsin
  • Lung development problems in utero and childhoof
  • Asthma
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5
Q

Spiro findings COPD

A
  • post BDR of less than 0.7 FEV1/FVC
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6
Q

CXR findings COPD

A
  • Enlarged lung fields
  • Flattened diaphragm
  • Air pockets (bullae)
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7
Q

FBC and COPD results

A
  • Elevated Ht and Hb - chronic hypoxia
  • Elevated RBC count
  • Elevated WBC if infection/inflammation
  • Can change platelet count
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8
Q

What is COPD and steroid responsiveness/asthmatic features?

A
  • Higher blood eosinophil count
  • Diagnosis of asthma or atopy
  • Substantial variation in FEV1 over time (at least 400mls)
  • Substantial diurnal variation in PEFR (at least 20%)
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9
Q

When can COPD with asthmatic features/steroid responsiveness occur?

A
  • Confirmed asthma but continues to smoke
  • Other atopic conditions and develops COPD
  • Person with COPD has raised eosinophil count
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10
Q

Other tests when COPD suspected

A
  • Alpha-1-antitrypsin
  • Heart disease investigations - ECG, NT-proBNP, echo
  • Other lung disease - CT thorax, sputum culture
  • O2 sats
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11
Q

Complications of COPD

A
  • Exacerbations
  • Cor pulmonale - pulmonary HTN from hypoxia, inflammation, loss of alveolar capillaries
  • T1RF/T2RF
  • Psychological problems and loss of functional ability
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12
Q

Aims of COPD treatment

A
  • Reduce symptoms
  • Reduce exacerbations
  • Improve QoL
  • Prevent deterioration of lung function
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13
Q

General management COPD

A
  • Holistic approach - control other resp and cardiac risk factors eg weight, diet, exercise
  • Smoking cessation
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14
Q

Non-pharmacological advice to offer in COPD

A
  • Healthy diet and physical activity - British Lung foundation or NHS COPD page
  • Stop smoking
  • Pneumococcal and flu vaccines
  • Pulmonary rehab
  • Personalised self management plan
  • Optimise treatment of co-morbidities
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15
Q

Vaccinations for COPD

A
  • Pneumococcal vaccine
  • Annual influenza
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16
Q

What is pulmonary rehab and when should it be offered, any scenarios where not appropriate?

A
  • Refer if functionally disabled by COPD - MRC 3 or above
  • OR recent hospitalisation for exacerbation
  • Do not refer if unable to walk or have unstable angina or recent MI
17
Q

When should LTOT be commenced?

A
  • Not without specialist assessment - treatment for HYPOXAEMIA and NOT breathlessness
  • Can improve survival if chronic hypoxia

Refer if:
* O2 sats 92% or less breathing air
* Very severe FEV1 (less than 30% predicted) or severe (FEV30-49%) airflow obsruction
* Cyanosis
* Polycythaemia
* Peripheral oedema
* Raised JVP
* Refer for ambulatory if mobile outdoors
* Warn people not to smoke - explosion risk but do not withdraw

18
Q

Pharmacotherapy for COPD - initial

A
  • Either SABA or SAMA
19
Q

Second line COPD treatment fir patients without asthmatic features/steroid responsivness

A
  • Offer LABA and LAMA - discontinue SAMA if LAMA is given
  • SABA is continued at all stages
  • If symptoms persist, severe exacerbation or 2 moderate exacerbations, consider addition of ICS (trial for 3 months if just for symptoms, others review annually)
20
Q

Step up treatment for those with asthmatic features/steroid responsive COPD

A
  • LABA and ICS
  • Review ICS annually
  • If severe exacerbations or 2 moderate within 1 yr/daily symptoms consider adding LAMA (remove SAMA if originally started)
21
Q

What is severe vs moderate COPD exacerbation?

A
  • Severe - hospitalisation
  • Moderate - systemic corticosteroids +/- antibacterial treatment
22
Q

Features of acute COPD exacerbation

A
  • Wheeze
  • Cough
  • Worsening breathlessness
  • Increased sputum volume/purulence
  • Fever without obvious source
  • URTI in last 5 days
  • Increased RR or HR 20% above baseline
23
Q

Severe exacerbation COPD features

A
  • Marked breathlessness and tachypnoea
  • Pursed lips breathing and or use of accessory muscles at rest
  • New onset cyanosis or peripheral oedema
  • Acute confusion/drowsiness
  • Marked reduction in ADLs
24
Q

What should you do whilst waiting for emergency services in acute COPD exacerbation?

A
  • Give O2 and monitor with pulse oximetry
  • Otherwise initially give O2 via venturi 24% at 2-3L/min or 28% at 4L/min or nasal cannula at 1-2L/min (if 24% venturi not available)
  • Target O2 sats 88-92% usually BUT not always - if not retainer, normal sat target
25
Q

If someone does not require admission for COPD, what treatments should you offer?

A
  • Advise to increase doses/freq of short acting bronchodilators (not exceeding max dose)
  • Consider oral corticosteroids for breathlessness that is interefering with daily activity
  • Consider need for abx - sputum colour change/increased thickness?
26
Q

Safety netting for someone not admitted with COPD exacerbation

A
  • Symptoms worsen (eg sputum changes/thickens)
  • Systemically unwell
  • Symptoms do not improve within given timeframe
27
Q

Follow up for someone with COPD exacerbation

A
  • Reassess if symptoms worsen rapidly/significantly at any time
  • Send sputum sample for culture and sensitivity if not improving on given abx
  • Follow up when stable (eg 6 weeks post exacerbation onset)
27
Q
A

General Practice YR3 (31 decks)

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