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module 103 - theme 4 > COPD > Flashcards

Flashcards in COPD Deck (27)
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1
Q

what is COPD?

A
  • preventable and treatable disease characterised persistent, progressive airflow limitation (not fully reversible)
  • enhanced chronic inflammatory response in the lungs to noxious gases/particles
2
Q

what happens with large airways inflammation?

A

airways narrowing due to chronic irritation of the bronchi causing inflammation and changes to the mucociliary escalator often results in a chronic cough

3
Q

what happens with the small airways?

A

airways narrowing due to bronchoconstriction and inflammation; duration and severity are risk factors for development or airway remodelling and COPD

4
Q

what happens with emphysema?

A

airways collapse due to destruction of alveolar walls - may lead to bullae

5
Q

what happens to the airways with COPD?

A
  • chronic inflammation
  • increased number of goblet cells
  • mucus hyperplasia
  • fibrosis
  • narrowing and reduction in the number of small airways
  • airway collapse due to alveolar wall destruction in emphysema
6
Q

what are the symptoms for chronic bronchitis (large airways)?

A
  • chronic productive cough for 3 months in 2 successive years
  • exclude other causes of chronic cough
7
Q

what are the symptoms of emphysema (alveolar)?

A
  • abnormal and permanent enlargement of the airspace due to destruction of the alveolar airspace walls
  • effects gas exchange
8
Q

what are the symptoms of small airways disease?

A

wheeze

9
Q

what are the risk factors of COPD?

A
  • cigarette smoke
  • occupational dust and chemicals
  • environmental tobacco smoke (ETS)
  • indoor and outdoor air pollution
  • genes
  • infections
  • socio-economic status
  • ageing population
10
Q

what smoking history do you need to take?

A
  • age started
  • calculate pack-year history
  • times stopped and why failed quit attempt
  • recreational drugs smoked (or other substances)
11
Q

how do you diagnose COPD?

A

symptoms + risk factors + spirometry

12
Q

what is the impact of grade 1 COPD?

A

not troubled by breathlessness except on vigorous exertion

13
Q

what is the impact of grade 2 COPD?

A

short of breath when hurrying or walking up inclines

14
Q

what is the impact of grade 3 COPD?

A

walks slower than contemporaries because of breathlessness or has to stop for breath when walking at own pace

15
Q

what is the impact of grade 4 COPD?

A

stops for breath after walking about 100m or stops after a few minutes walking on the level

16
Q

what is the impact of grade 5 COPD?

A

too breathless to leave the house or breathless on dressing or undressing

17
Q

what are the physical signs of COPD?

A
  • barrel shaped chest
  • hyperresonant percussion
  • accessory muscles
  • prolonged expiration
  • pursed-lip breathing
  • tripod position
  • low BMI
  • nicotine staining
18
Q

what are the physiological effects of COPD?

A
  • increased work of breathing
  • reduced exercise tolerance
  • impaired gas exchange: hypoxia, hypercapnia, raised pulmonary artery pressure, RV dilatation, cor pulmonale
  • loss of fat-free mass
19
Q

how do you manage chronic COPD?

A
  • stop smoking
  • if symptomatic LABA/LAMA combined inhaler
  • lots of inhalers
  • flu vaccination
  • educate and empower
  • treat exacerbations
  • pulmonary rehabilitation
  • think about the whole patient (bones, nutrition, mental health)
  • LTOT
20
Q

what happens with pulmonary rehabilitation?

A
  • 2x supervised sessions for 6 weeks
  • supervised exercise
  • education
  • psychosocial support/group work
21
Q

what are the other possible treatments for COPD?

A
  • theophylline (oral phosphodiesterase inhibitor)
  • azithromycin 3x a week (anti-inflammatory antibiotic prophylaxi)
  • lung volume reduction surgery
  • lung transplantation
22
Q

what is acute exacerbation?

A

acute deterioration in symptoms requiring additional therapy

  • mild (SABA)
  • moderate (SABA +/- steroids +/- antibiotics)
  • severe (hospital admission) or ED attendance
23
Q

what happens with severe exacerbation of COPD?

A

ED attendance due to progressive dyspnoea/hypoxia or signs of infection or signs of right heart failure

  • antibiotics in signs of infection
  • oral steroids
  • target saturation 88-92%
  • nebulisers
  • consider diruetics
  • nicotine replacement therapy/refer for smoking cessation
24
Q

why do you use non-invasive ventilation for COPD?

A

decompensated hypercapnic respiratory failure despite controlled oxygen and nebuliser treatments

25
Q

why do you consider invasive mechanical ventilation for COPD?

A

respiratory failure despite nebulised therapy and controlled oxygen and patient unable to tolerate NIV

26
Q

when do you palliate for COPD?

A

respiratory ventilation on background of significant progressive decline over several months/years with no evidence of reversible event

27
Q

how do you control the symptoms of COPD?

A
  • oromorph
  • lorazepam
  • fan therapy
  • oxygen therapy
  • CBT
  • pacing/breathing strategies
  • hospice input