TREATMENT OF COPD Flashcards
The difference between COPD and Asthma
Asthma
* Young age onset, usually < 20 years.
* History of hay fever, eczema and/or
allergies.
* Family history of asthma.
* Symptoms are intermittent with periods
of normal breathing in between.
* Symptoms are usually worse at night or in
the early hours of the morning, during an
upper respiratory tract infection, when
the weather changes, or when upset.
* Marked improvement with beta2 agonist.
COPD
Differences between asthma and COPD
* Older age onset, usually > 40 years.
* Symptoms slowly worsen over a long
period of time.
* Long history of daily or frequent cough
before the onset of shortness of breath.
* Symptoms are persistent rather than only
at night or during the early morning.
* History of heavy smoking (> 20
cigarettes/day for ≥15 years), heavy
cannabis use, or previous TB.
* Little improvement with beta2 agonist.
what is COPD
abnormally inflammatory response of the lungs to the irritants and gases with progressive reduction in airflorw.
Differentiates betweem emphysema and chronic bronchitis
Emphysema incurable lung diseases where alveolar fill up air, and lung surface is gradually reduced and difficult in breathing
Chronic bronchitis: inflammation lining of bronchial tubes which carries air from and to the lungs
Causes of COPD
related to chronic irritation of the lungs caused by cigarette
smoking > 10 yrs, marijuana smoking, Post-tuberculosis, inhalation of
fossil fuels, mining: dust exposure & pollutants
symptoms of emphysema and chronic bronchitis
Symptoms
* chronic cough with/without sputum production on most days for 3 or
more months for 2 or more consecutive years
* Dyspnoea / shortness of breath
* Wheezing
The onset is very gradual with progressively worsening symptoms. Due to
the large reserve capacity of the lungs, patients often present when there is
considerable permanent damage to the lungs.
* Manifestations of right-sided heart failure
* Acute bronchitis after a cold / flu
which values are decreased or increased in spirometry for emphysema
Decreased FEV
Decreased forced vital capacity
Increase in air trapped in the lungs: increase residual volume
List the general measures for chronic bronchitis
exercise
chest physiotherapy where available
smoke cessation, including cannibian (dagga) is the mainstay of therapy
COPD medicine treatment STEP 1
SABA
Salbutamol, inhalation, 3-4 times a day as needed for relief of wheeze
COPD medicine treatment Step 2
If not controlled on SABA alone and diagnosis was confirmed by
spirometry (with < 2 exacerbations per year): ADD
* Long-acting β2-agonist (LABA), e.g.:
* Formoterol, inhaled 12 hourly.
OR
If not controlled on SABA alone and spirometry not available:
* Inhaled LABA/corticosteroid combination e.g.:
* Salmeterol/fluticasone, inhalation, 12 hourly.
COPD Medicine treatment Step 3
If not controlled on a LABA alone or frequent exacerbations (≥ 2 per
year):
Replace with:
* Inhaled LABA/corticosteroid combination e.g.:
* Salmeterol/fluticasone, inhalation, 12 hourly
If not controlled on step 3: ADD
* Theophylline, slow release, oral at night, stop of no benefit after 12
months
which drugs interact with protease inhibitor
fluticasone and budesonide
acute exarcabation is characterised by what?
wheeze
breathless
tightness in the chest
respiratory distress
cough
Bronchospasm is ———— reversibly in COPD.
partially
treatment of acute exarcebation and note
Oral corticosteriods
Prednisole, oral 30mg daily, 5 days
Oral corticosteroids may be required for acute exacerbations,
but these have severe long-term complications and should only be
used long-term if benefit has been proven by lung function testing.
treatment of acute exarcebation of chronic brochititis
Amoxicillin oral, for 5 days
severe penicillin allergy
Doxcycline oral, for 5 days
