COPD

?
  • Created by: LBCW0502
  • Created on: 01-03-19 10:47
Outline the epidemiology of asthma and COPD (1)
Asthma (highest self reported rates in world, >5.4 million people affected, 1.1 million children in UK, 1410 people died from asthma in 2016, NHS spends £1 bn/year treating/caring for people with asthma)
1 of 31
Outline the epidemiology of asthma and COPD (2)
COPD (leading cause of morbidity/mortality worldwide, 3 million people have COPD in the UK, in 2012 29,776 people died from COPD, 15% admitted with COPD die within 3 months, direct annual cost of <£800 million)
2 of 31
What is COPD? (1)
Chronic Obstructive Pulmonary Disease - common, preventable and treatable disease characterised by - persistent respiratory symptoms and airflow limitation (FEV1/FVC <0.7)
3 of 31
What is COPD? (2)
Caused by a mixture of small airways disease e.g. obstructive bronchiolitis and parenchymal destruction (emphysema) - GOLD
4 of 31
Outline the pathology of COPD (1)
Mucus hypersecretion, inflammation, small airways (obstruction), loss of elastic recoil, acinus
5 of 31
Outline the pathology of COPD (2)
Mucuous hypersecretion, ciliary dysfunction, airflow limitation, lung hyperinflation, abnormal gaseous exchange, pulmonary hypertension
6 of 31
Outline the pathology of COPD (3)
Cigarette smoke - affects alveolar macrophages, epithelial cells, CD8+ cell (Tc1)/neutrophils - small airway narrowing, alveolar destruction - airflow limitation - irreversible
7 of 31
What are the risk factors for COPD?
Smoking, occupational dusts and chemicals, indoor air pollution (burning of open fires/wood/coal), global population at risk (M.East, Africa, Asia). Genetics - alpha 1 antitrypsin deficiency (Northern European origin)
8 of 31
Describe features of smoking and effects of age
If you stop smoking before <45 years of age, it is possible to have normal lung function. If you stop smoking >45 years of age, lung function may not return to normal
9 of 31
Describe features of smoking as a risk factor
Implicated in chronic bronchitis and emphysema since 1960s. Risk of developing COPD is dose related and affected by age smoking is started. Smoking pack years: total pack years = number of cigarettes per day x number of years of smoking / 20
10 of 31
Describe features of alpha 1 antitrypsin deficiency
Elastin (responsible for recoil function). Deficiency of elastase breakdown, build up of elastin, leads to damage to alveolar wall
11 of 31
What are the symptoms of COPD
Dyspnoea (MRC scale). Chronic cough (earliest sign, discounted as sign of ageing). Sputum (chronic bronchitis >3 months in 2 consecutive years, change in colour/volume - COPD exacerbation). Other - wheeze, chest tightness, fatigue
12 of 31
Outline features of the MRC dyspnoea scale
Ask patient about degree of breathlessness related to activities e.g. walking. Give score (not all patients might be breathless/exercise tolerance)
13 of 31
Outline features of the COPD Assessment Test
CAT score. Found in 15 different languages. 8 Qs. Asks about symptoms e.g. cough, breathlessness etc. Change in score gives indication of effectiveness of treatment or deterioration of COPD
14 of 31
Describe features of spirometry
FEV1 (forced expiratory volume in in 1s), FVC (forced vital capacity). FEV1/FVC ratio. Look at % predictor for FEV1 and FVC (not for ratio) - compared to normal population (considers gender, age, height). <0.7 ratio (indicates COPD/obstructive)
15 of 31
Describe features of COPD diagnosis (1)
Consider symptoms such as dyspnoea, chronic cough, sputum production, history of exposure to risk factors. Spirometry confirmation of FEV1/FVC < 0.7. Assessment aims to determine severity of airway limitation, impact on health status (symptoms)
16 of 31
Describe features of COPD diagnosis (2)
Future risks (exacerbations, admissions)
17 of 31
What are the clinical features of asthma?
Possibly a smoker, often under 35 years old, chronic production cough is uncommon, variable breathlessness, common to be wheezing in the night, common for day-to-day variability of symptoms
18 of 31
What are the clinical features of COPD?
Smoker, rare to be under 35 years old, common to have chronic productive cough, persistent/progressive breathlessness, uncommon to be wheezing at night, uncommon to have day-to-day variability of symptoms
19 of 31
Which guidelines can be used for COPD severity?
NICE guidelines (also GOLD guidelines)
20 of 31
What does the ABCD assessment tool consider?
GOLD guidelines - spirometry diagnosis, severity, symptoms (MRC score, CAT score, exacerbations)
21 of 31
What are the management goals for COPD?
Prevent disease progression, reduce symptoms, reduce exacerbations, improve health status/exercise tolerance/QOL, reduce mortality
22 of 31
Describe features of smoking cessation and pulmonary rehab (1)
If MRC score of >2. Hospital admission due to COPD exacerbation. Improve QOL/exercise capacity, decrease dyspnoea, NNT = 3. Mortality benefit over 107 weeks, NNT = 6. Not suitable for recent MI, unstable angina, unable to walk
23 of 31
Describe features of smoking cessation and pulmonary rehab (2)
Other management - vaccinations (annual influenza), pneumococcal, decrease hospital admissions and mortality
24 of 31
Describe features of management using oxygen
Hypoxia can occur in severe COPD (only thing helping patients breath due to being unable to remove CO2/driving force for respiration), if untreated (cor pulmonale), 5 year survival of <50%, minimum 15 hours/day (maximal benefits 20 hrs/day)
25 of 31
What are the pharmacological treatment for management of COPD?
Inhaled therapies, mucolytics, carbocisteine, NAC (reduces sputum viscosity, aid expectoration), surgery in end stage
26 of 31
Outline the cost effective treatment
Pyramid. Flu vaccination, smoking cessation, pulmonary rehabilitation (not in reality - more money in therapies/inhalers, less focus on smoking cessation)
27 of 31
Outline features of inhaled therapies (1)
Different classes - SABA, LABA, LAMA, LAMA/LABA, LABA/ICS, LABA/LAMA/ICS, SAMA (strengths are COPD specific
28 of 31
Outline features of inhaled therapies (2)
SABA/LABA (beta agonists, GCRPs, increase cAMP, short/long acting, SE- tremor, headache, palpitations). SAMA/LAMA (muscarinic antagonists, prevent ACh binding to cause contraction, short/long acting, side effects e.g. dry mouth, tachycardia etc.)
29 of 31
Outline the evidence for inhaled therapies (1)
LABA/LAMA - maximum bronchodilation effects, better FEV1, better than monotherapy, reduces exacerbations. ICS/LABA - higher eosinophil, reduce exacerbations
30 of 31
Outline the evidence for inhaled therapies (2)
LAMA/LABA improve FEV1, SABA helpful but regular use not recommended, LAMA improves symptoms, LAMA superior to LABA (in exacerbation/hospitalisation reduction)
31 of 31

Other cards in this set

Card 2

Front

Outline the epidemiology of asthma and COPD (2)

Back

COPD (leading cause of morbidity/mortality worldwide, 3 million people have COPD in the UK, in 2012 29,776 people died from COPD, 15% admitted with COPD die within 3 months, direct annual cost of <£800 million)

Card 3

Front

What is COPD? (1)

Back

Preview of the front of card 3

Card 4

Front

What is COPD? (2)

Back

Preview of the front of card 4

Card 5

Front

Outline the pathology of COPD (1)

Back

Preview of the front of card 5
View more cards

Comments

No comments have yet been made

Similar Pharmacy resources:

See all Pharmacy resources »See all COPD resources »