COPD Flashcards by Sumaya L

What does the rescue pack for COPD contain?

Amoxicillin
Corticosteroid like prednisolone

How well did you know this?

Not at all

Perfectly

What is given for prophylaxis fo COPD exacerbation?

For exacerbations of 4 or more in a year, azithromycin is given 3 x a week

How well did you know this?

Not at all

Perfectly

What is Grade 1 COPD?

Over 80%

How well did you know this?

Not at all

Perfectly

What is Grade 2 COPD?

50-79%

How well did you know this?

Not at all

Perfectly

What is Grade 3 COPD?

30-49%

How well did you know this?

Not at all

Perfectly

What is Grade V COPD?

Less than 30%

How well did you know this?

Not at all

Perfectly

Which investigations to perform for COPD?

Spirometry: FEV1/FVC ratio should be less than 0.7
Sputum culture
FBC for polycythaemia fromc chronic hypoxaemia or anaemia of chronic disease
ECG findings correlating with RHF
CXR

How well did you know this?

Not at all

Perfectly

What are the CXR findings?

Flattening of diaphragm
Bullae

How well did you know this?

Not at all

Perfectly

What is first line for patients who are limited by breathlessness?

SABA or SAMA

How well did you know this?

Not at all

Perfectly

What is given for patients with features of asthma and steroid responsiveness?

LABA and ICS

How well did you know this?

Not at all

Perfectly

What is third line?

LABA + LAMA + ICS

How well did you know this?

Not at all

Perfectly

What can be given additionally if not stabilised with 3rd line therapy and asthma features/steroid responsive?

Oral steroid
Oral theophylline
Oral phosphodiesterase-4 inhibitor like roflumilast

How well did you know this?

Not at all

Perfectly

What is given for a COPD patient with significant symptoms but no exacerbation?

LAMA or LABA
-> if symptoms persist, escalate to dual therapy

How well did you know this?

Not at all

Perfectly

What is given for patients with 2 exacerbations OR 1 hospitalisation?

LAMA is first line unless asthmatic features then LABA + ICS

How well did you know this?

Not at all

Perfectly

What is given for patients with 2 exacerbations OR 1 hospitalisation and LAMA is ineffective?

Dual therapy

How well did you know this?

Not at all

Perfectly

What is the surgical managmeent for COPD?

Lung volume reduction

How well did you know this?

Not at all

Perfectly

Which patients should be referred for LTOT?

Oxygen saturations <92% in air or cyanosis
FEV1 <30% predicted (consider referring if <49%)
Polycythaemia
Peripheral oedema or raised jugular venous pressure (suggesting cor pulmonale)

How well did you know this?

Not at all

Perfectly

What should the ABG values be for LTOT?

PaO2 below 7.3kPa
PaO2 7.3-8kPa with any of secondary polycythaemia, peripheral oedema or pulmonary hypertension

How well did you know this?

Not at all

Perfectly

When is non-invasive ventilation given?

I level positive airway pressure for uncompensated Type 2 respiratory failure, where CO2 is more than 6 and PaO2 is less than 8

How well did you know this?

Not at all

Perfectly

How well did you know this?

Not at all

Perfectly

How to determine between infective exacerbation and infection?

CXR findings will show pacification for infection
There will be an absence of a wheeze

How well did you know this?

Not at all

Perfectly

When is non-invasive ventilation used in COPD?

Hypercapnic respiratory failure for respiratory acidosis

How well did you know this?

Not at all

Perfectly

When should non-invasive ventilation be avoided?

When patients lose their hypoxia respiratory drive due to overoxygenation

How well did you know this?

Not at all

Perfectly

How is overoxygenation of patients in COPD present?

Reduced work of breathing, looking a calmer from CO2 narcosis with hypoxia but oxygen saturation of 93% or higher. Therefore they should be switched onto a lower oxygen mask to achieve a target saturation of 88-92%.

How well did you know this?

Not at all

Perfectly

What to do if a COPD patient is hypoxic and ABG is not available?

Provide high flow oxygen due to risk of type 2 respiratory failure

Which investigation is sued to confirm COPD?

Spirometry

When is PEFR used as an investigation?a

Asthma

What is considered an asthmatic feature?

Atopic dermatitis

How does high oxygen worsen hypercapnic ventilation?

V/Q mismatch - chronic lung damage from COPD causes the lungs to compensate by vasoconstricting the blood vessels in these areas and vasodilating the ones in the healthy areas. Excess oxygen causes vasodilation of the blood vessels throughout the lungs, increasing the amount of blood going to the damaged alveoli and impairing effective gas exchange. The Haldane effect - at higher concentrations of oxygen, more carbon dioxide is released from haemoglobin into the circulation.(resulting in hypercapnia).

What is the indication for LTOT?

The criteria defined for offering LTOT to patients with COPD are: pO2 <7.3 kPa OR pO2 7.3 - 8 kPa AND one of the following: secondary polycythaemia, peripheral oedema, or pulmonary hypertension

What is the oxygen flow for 24% Venturi mask in COPD?

2-4 L

What inital oxygen therapy for patients with type 2 resp failure in COPD?

4L of oxygen via Venturi mask at 24-28%, aiming for target sat of 88-92% Bronchdoiator therapy Steroids

What should be given if patient fails to respond to ventricular mask oxygen?

Over 1 hour and they remain in respiratory fialure, give non-invasive ventilation Steroids

What is the V/Q mismatch in COPD?

Low due to decreased ventilation but higher perfusion because of greater cardiac output

How to differentiate between acute and chronic respiratory acodiosis?

High bicarbonate levels in chronic because of chronic compensation

ECG findings for COPD?

Right axis deviation Prominent p waves in inferior leads Inverted P waves in lateral dead’s Delayed R/S transition Multi focal atrial tachycardia

What increases survival in COPD?S

Smoking cessation Long term oxygen therapy

What are the asthmatic features? d

Diurnal variation worse at. Night and early morning Eczema

What is the oxygen flow in 28% Venturi mask inCOPD?

4L/min

What is used to grade COPD severity?

GOLD criteria: GOLD A 0–1 exacerbations per year + fewer symptoms GOLD B 0–1 exacerbations per year + more symptoms GOLD C 2 or more exacerbations per year + fewer symptoms GOLD D 2 or more exacerbations per year + more symptoms

What is the criteria for COPD admission?

severe breathlessness acute confusion or impaired consciousness cyanosis oxygen saturation less than 90% on pulse oximetry. social reasons e.g. inability to cope at home (or living alone) significant comorbidity (such as cardiac disease or insulin-dependent diabetes)

Which virus causes COPD exacerbation?

Human rhinovirus

Which bacteria causes COPD exacerbation other than haemophilus influenza?

Streptococcus pneumoniae Moraxella catarrhalis

What is given for COPD exacerbation?

increase the frequency of bronchodilator use and consider giving via a nebuliser give prednisolone 30 mg daily for 5 days

When to give antibiotics for COPD exacerbation?

If sputum is purulent or clinical signs of pneumonia

What is the first line drugs for COPD exacerbation?

the BNF recommends one of the following oral antibiotics first-line: amoxicillin or clarithromycin or doxycycline.

What is the criteria for using non-invasive ventilation?

typically used for COPD with respiratory acidosis pH 7.25-7.35 NIV can be used in patients who are more acidotic (i.e. pH < 7.25) but that a greater degree of monitoring is required (e.g. HDU) and a lower threshold for intubation and ventilation should be

What is the level of BiPAP usedf or expiratory

4-5cm H20 for expiratory

What is the level of BiPAP used for Inspiratory?

12-15cm H20

Which materials can cause COPD?

Coal Cotton Cement Grain

What should be done before prescribing azithromycin?

LFTs and ECG to exclude QT prolongation due to risk

What is reccomended for cor pulmonale?

Loop diuretics -> not any other medications

What is an indicator for lung reduction surgery?

Predominant upper lobe emphysema FEV1>20% predicted, PaCO2 <7 and Transfer capacity of the lung for carbon monoxide (TlCO) >20%.

What does signet ring indicate on CT?

Bronchieactasis sats the bronchus is dilated

What reduces exacerbations of Bronchieactasis?

Postural drainage, a type of chest physiotherapy done twice a day

What are the vaccinations for COPD?

Annual influenza and one off pneumococcal

What to give for COPD exacerbation with clear sputum?

5 day prednisolone course

What to give for COPD exacerbation with purulent sputum?

Oral 5 day course of doxycycline Collapse with cold

What is given to imrpove prognsois in COPD?

Oral coritcosteroids

Which CRP level should antibiotcs therapy be offered?

CRP over 100

Which CRP level should delyed antibiotcs therapy be offered?

CRP 20-100

Which COPD patients benefit from non-invasive ventilation?

7.25-7.35

When to prescribe antibiotics for COPD?

purulent sputum or clinical signs of pneumonia

What happens with overoxygenation in COPD?

Acute respiratory acidosis with high CO2

What is required to diagnose COPD?

CXR and post bronchodilator spirometry

When to assess for LTOT?

Using ABG for patients that are clinically stable, typically at least 4-6 weeks after an exacerbation.

What to suspect with hyponatraemia and weight loss?

Lung cancer

What do inhaled corticosteroids increase risk for?

Pneumonia

What changes target oxygen saturation in COPD?

Normal PCO2 means target oxygen saturation is 94-98%

What must be given in COPD regardless of exacerbation?

Steroid

What should be offered to patients with COPD if response to nebulised bronchodilators is poor?

IV theophyllines

What investigation is idnicated in purulent COPD patient?

Sputum microscopy and culture

What investigation is idnicated in Pyrexia COPD patient?

Blood culture

How does BiPap work?

works by stenting alveoli open to increase the surface area available for ventilation and gas exchange, best in COPD?

When to escalate amangement to secondary care for COPD patients!

NICE recommends considering prophylactic oral macrolide therapy (e.g. azithromycin) or long term steroids for people with COPD who have had more than three exacerbations requiring steroid therapy and at least one exacerbation requiring hospital admission in the previous year.

What determines COPD severity?

FEV1

How is TLCO affected in COPD?

Reduced due to the destruction of the alveolar wall, the surface available for diffusion is reduced

How is lung capacity affected in COPD?

Increased total lung capacity from hyper expansion

What to do second line in COPD patient THAT has no asthmatic features

Combination LABA and LAMA

COPD Flashcards

(81 cards)