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competency 10/11 > respi: copd > Flashcards

respi: copd Flashcards

1
Q

COPD is characterised by

A

qpersistent respiratory sx and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases
- chronic bronchitis
- emphysema

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2
Q

chronic bronchitis

A
  • consists of persistent cough + sputum production
  • for most days of 3 months in a year for at least 2 consec years
  • independent disease entity, that may occur before or after the development of airflow limitation
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3
Q

emphysema

A
  • abnormal permanent enlargement of the airspaces distal to terminal bronchioles
  • accompanied by destruction of their walls +/- obvious fibrosis
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4
Q

risk factors for copd

A
  • tobacco smoking
  • indoor/outdoor air pollution
  • occupational exposures
  • genetic factors - severe hereditary alpha-1 antitrypsin deficiency: early onset of lung damage
  • age and sex - aging and female sex incr risk
  • lung growth and development
  • socioeconomic status: inversely related
  • asthma and airway hyper-reactivity
  • chronic bronchitis: incr freq of exacerbations
  • infections: hx of severe childhood infection
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5
Q

copd should be considered in any pt who has

A

dypsnea, chronic cough, sputum production, hx of exposure to risk factors

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6
Q

dyspnea that is

A

progressive over time, characteristically worse with exercise, persistent

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7
Q

chronic cough

A

may be intermittent and may be unproductive
- recurrent wheeze
- present throughout the day, seldom nocturnal only

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8
Q

GOLD 1

A

> = 80

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9
Q

GOLD 2

A

50-79

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10
Q

GOLD 3

A

30-49

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11
Q

GOLD 4

A

<30

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12
Q

mMRC grade 0

A

only breathless w strenuous exercise

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13
Q

mMRC grade 1

A

short of breath when hurrying on the level or walking up a slight hill

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14
Q

mMRC grade 2

A

walk slower than people of the same age on the level because of breathlessness, or have to stop for breath when walking on my own pace on the level

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15
Q

mMRC grade 3

A

stop for breath after walking about 100 meters or after a few mins on the level

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16
Q

mMRC grade 4

A

too breathless to leave the house or when dressing/undressing

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17
Q

CAT: <10

A

low impact on life
>= 10: consider regular treatment for sx

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18
Q

CAT: >30

A

high impact on life, can barely leave house

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19
Q

CAT: how many points change will suggest a clinically significant change in health status?

A

2

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20
Q

Spiriva

A

tiotropium

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21
Q

Incruse

A

umeclidinium

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22
Q

Onbrez

A

indacaterol

23
Q

Relvar

A

vilanterol + fluticasone

24
Q

Seretide

A

salmeterol + fluticasone

25
Q

Symbicort

A

formoterol + budesonide

26
Q

regular treatment with ICS

A

incr risk of pneumonia esp in those w severe disease

27
Q

LTRA use in copd

A

not tested adequately

28
Q

simvastatin use in copd

A

does not prevent exacerbation in copd pt at incr risk of exacerbations and without indications for statin therapy
- but observational studies suggest that statins may have pos effects on some outcomes in pts with copd who receive them for cv and metabolic indications

29
Q

PDE4i in copd

A

in pt w chronic bronchitis, severe to moderate copd and a hx of exacerbation - can improve lung function and decr exacerbations

30
Q

oral glucocorticoids use in copd

A

long term use has numerous side effects with no evidence of benefits

31
Q

theophylline in copd

A

low dose reduce exacerbations but does not improve post-bronchodilator lung function

32
Q

theophylline adr

A
  • n/v, diarrhea
  • incr urination
  • incr hr, palpitations
  • breathlessness
  • insomnia
  • can cause seizures in toxic levels (has narrow therapeutic window)
33
Q

initial pharmacological treatment: group A

A

bronchodilator: SABA or SAMA

34
Q

initial pharmacological treatment: group B

A

long-acting bronchodilator: LABA or LAMA

35
Q

initial pharmacological treatment: group C

A

LAMA

36
Q

initial pharmacological treatment: group D

A

LABA+LAMA or ICS+LABA

37
Q

when deciding whether or not to initiate ICS therapy, consider these factors:

A
  • freq of exacerbations
  • hosp for an exacerbation
  • blood eosinophil count
  • hx of or concurrent asthma
  • hx of repeated pneumonia
  • hx of mycobacterial infection
38
Q

azithromycin

A

may reduce exacerbation rate, esp in ex-smokers
- 250mg/d or 500mg 3x/wk for 1 year

39
Q

azithromycin adr

A

stomach cramps, diarrhea
long term use, concern of ototoxicity eg. hearing impairment

40
Q

PDE4i: roflumilast

A
  • Reduce inflammation by inhibiting the breakdown of
    intracellular cyclic AMP
  • Reduces moderate and severe exacerbations treated with
    systemic steroids in patients with severe to very severe
    COPD
  • Benefits greater in patients with a prior history of
    hospitalisation for an acute exacerbation
  • Adverse effects: diarrhea, nausea, reduced appetite,
    weight loss, abdominal pain, sleep disturbance,
    headache, depression
  • Not registered in Singapore
41
Q

vaccinations

A

influenza: all
PCV13 and PPSV23: >65yo, younger pt w significant comorbid conditions incl chronic heart or lung disease
covid-19: all
Tdap (dTaP/dTPa): adults who were not vaccinated in adolescence to protect against pertussis (whooping cough)

42
Q

Long-term oxygen therapy (LTOT) is indicated for stable
patients who have:

A
  • PaO2 at or below 7.3 kPa (55 mmHg) or SaO2 at or below 88%,
    with or without hypercapnia confirmed twice over a three week
    period; or
  • PaO2 between 7.3 kPa (55 mmHg) and 8.0 kPa (60 mmHg), or
    SaO2 of 88%, if there is evidence of pulmonary hypertension,
    peripheral edema suggesting congestive cardiac failure, or
    polycythemia (hematocrit > 55%).
  • Shown to improve survival in patients with severe resting
    hypoxemia
43
Q

exacerbation of copd

A

an acute event
characterized by a worsening of the patient’s
respiratory symptoms that is beyond normal dayto-
day variations and leads to a change in
medication.”

44
Q

exacerbations are classified as

A

mild, moderate, severe

45
Q

mild exacerbation

A

treat w short-acting bronchodilators only

46
Q

moderate exacerbation

A

treat with short-acting bronchodilators plus antibiotics and/or corticosteroids

47
Q

severe exacerbation

A

pt requires hospitalisation or visits the emergency room. may be a/w acute respiratory failure

48
Q

o2 therapy

A

maintain PaO2>60mmHg or SaO2 = 88-92%

49
Q

corticosteroids

A

prednisolone PO 40mg OM x5d
- longer courses may be a/w incr risk of pneumonia and mortality

50
Q

role of vit d in immune modulation

A

All patients hospitalised for exacerbations should be assessed
and investigated for severe deficiency (<10 ng/ml) and given
vitamin D supplementation if required

51
Q

methylxanthines

A

(theophylline) not recommended due to incr side effect profile

52
Q

indications for antibiotics

A
  • Patients with 3 “cardinal symptoms” (i.e., worsening
    dyspnea, increased sputum purulence and increased
    sputum volume)
  • Patients with 2 “cardinal symptoms” if increased sputum
    purulence is one of them
  • Severe exacerbations that require mechanical
    ventilation (invasive or non-invasive)
  • Consider other indicators of infection
  • Fever
  • Increased WBC count
  • CRP, procalcitonin
  • Changes on chest X-ray
53
Q

most common bacteria

A
  • Haemophilus influenzae
  • Streptococcus pneumoniae
  • Moraxella catarrhalis

competency 10/11 (31 decks)

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