12. COPD and A1AT Deficiency Flashcards
What are the causes of COPD?
Smoking Biomass fuel burning, sulphur dioxide, occupational dusts Chest infections under the age of 1 Adenovirus HIV (increases effects of smoking)
What are the symptoms of COPD?
Cough
Sputum production (greyish)
Dyspnoea
Wheeze/chest tightness
What are the symptoms of an acute exacerbation of COPD?
Increase in shortness of breath and wheeze
Productive cough with change in sputum
Pleuritic pain
Ankle oedema, orthopnoea, paroxysmal noctural dyspnoea
What is paroxysmal nocturnal dyspnoea?
Shortness of breath while asleep, causing patient to wake up
What are the signs of COPD on inspection?
Central cyanosis
Tripod position and using accessory muscles
Pursed lip breathing
Hyperinflation
What are the signs of COPD on percussion?
Hyperresonance and loss of cardiac dullness
What are the signs of COPD on auscultation?
Decreased breath sounds
wheeze
Increased expiratory time
What are the signs of CO2 retention?
Warm hands
Dilated veins
Asterixis
What diseases can be included in the differential of an acute COPD exacerbation?
Acute congestive cardiac failure Acute MI PE Pneumonia Asthma Mucous plugging
What investigations should be done for management of an acute exacerbation?
ABG
CXR
FBCs, U&E, CRP
What are the aims for management of an acute exacerbation of COPD?
Oxygenation
pH
Relieve bronchospasm
Treat infection
What piece of equipment is used for oxygenation in COPD?
Venturi face mask
What is the danger of hyperoxygenation in COPD?
COPD causes the patient’s body to adjust to high CO2 levels by increasing bicarb levels to keep stable
If the pH is brought too high the body’s natural drive to breathe will be cut off
What are the options for maintaining pH during an acute exacerbation?
Non-invasive positive pressure ventilation with bi-level positive pressure
invasive ventilation
Why is invasive ventilation avoided where possible?
Can cause a pneumothorax
What steroids are used in acute exacerbations?
Hydrocortisone, with a PO switch to prednisone
What are the options for bronchodilators in COPD?
Long/short acting B-agonists
Long/short acting anti-cholinergics
Methylxanthines
What form of pulmonary rehab is used in COPD?
Aerobic lower extremity training: able to more easier recognise SOB and increases exercise tolerance
What treatment should be given to a patient with severe airway obstruction that can’t be controlled by long-actiing bronchodilators?
Inhaled corticosteroids
What are the complications of COPD?
Type 2 respiratory failure
Cor pulmonale
Recurrent chest infections
Death
How many hours a day is long-term oxygen therapy given to a COPD patient with respiratory failure?
> 16
What monitoring is needed for a patient on long term oxygen therapy?
CO2 and O2 confirmed twice over 3 weeks using an ABG
What surgeries might be done on a patient with COPD?
Bullectomy
Lung volume reduction
Lung transplant
What is the only recognised cause of inherited COPD?
a-1-antitrypsin deficiency
What is the genotype of severe a1AT deficiency?
Pi ZZ
What is the genotype of heterozygous a1AT deficiency?
MZ
How is a1AT deficiency diagnosed?
Blood levels
Genotype
What disease is a1AT also related to?
Vasculitis
