10. COPD Flashcards
What is COPD?
Progressive airway obstruction with little or no reversibility. It includes chronic bronchitis and emphysema
Describe the pathophysiology of COPD
Mucousal gland and goblet cell hyperplasia, inflammation and fibrosis is a smaller component- bronchecstasis
bronchiolar dilation and loss of alveolar tissue. Loss of alveolar attachements (elastic recoil lost)- emphysema
Describe the epidemiology of COPD
Onset>35, smoking or pollution related
What are symptoms of COPD?
Cough, sputum, dyspnoea, wheeze
What are the signs of COPD?
Tachynpoea, use of accessory muscles.
hyperinflation, reduced cricosternal distance,
hyperreasonant percussion note
What are the complications of COPD?
Acute exacerbations, respiratory failure
polcythemia, cor pulmonale, lung cancer
pneumothorax (from ruptured bulla (air filled space))
What tests may you want to do for COPD?
FBC- polyctheamia vera
CXR- hyerinflation, flat hemidiaphragms,
ECG- cor pulmonale changes (RA and RV hypertrophy)
ABG
Spirometerty
What treatments are there for stable COPD?
Smoking cessation advice encourage exercise BMI is often low, diet advice and supplements Mucolystics Depression screening Respiratory failure diuretics flu and pneumococcal vaccinations
What is the problem with giving those with COPD oxygen?
They may become more hypoxic due to the fact they rely on hypoxic drive to stay ventilated. Oxyegn sats should be between 88-92%
According to the 2018 COPD Grampian guidlines how should an individual with COPD and episodes of breathlessness be mananaged?
SABA (using daily then escalate to…)
SABA and LAMA (if breathless during daily activities…)
SABA and LAMA/LABA (if breathless during daily act..)
STOP, THINK, REVIEW
According to the 2018 COPD Grampian guidelines how should an individual with COPD and episodes of acute exacerbation be managed?
SABA and LAMA (if breathless during daily activities…)
SABA and LAMA/LABA (if breathless during daily activities AND Fev1<50% then…)
STOP, THINK, REVIEW
What is involved in stop, think, review?
Consider smoking cessation Consider inhaler technique and concordance Consider self management Refer for pulmonary rehab Assess and optimise co-morbid treatments Assess if suitable for oxygen therapy
What do patients with COPD greatly appreciate?
Pulmonary rehabilitation- exercises, lung training and physiotherapy to improve lung health in those who have lung conditions.
What is a rare differential for COPD
When should it be suspected?
a1 antityrpsin deficiency (same stuff not caused by smoking)
COPD in patient who is under 40, or has a history of less than 10 pack years.
What is long term oxygen therapy?
Trials have shown that keeping oxygen over 8kPa for 15 horus a day, 3 yr survivial improved by 50%.
It is used for terminally ill patients, non smokers who arent repsnding to treatment or have pulmonary hypertension, polycythemia or peripheral oedema.
