3+ COPD Flashcards
What is COPD?
Progressive disorder characterised by airway obstruction (decreased FEV1 and decreased FEV1/FVC) with little to no reversibility
What are the two types of conditions that classify as COPD?
Chronic Bronchitis:
- Defined clinically as a productive cough for at least 3 months each year for 2 consecutive years
Emphysema:
- Defined histologically as enlarged air spaces distal to the terminal bronchioles due to destruction of the alveolar walls
Are males or females more likely to get COPD?
M
What is the aetiology of COPD?
Exogenous:
- Tobacco smoking
- Air pollution
- Occupational exposures
- Recurrent pulmonary infections/TB
- Premature birth
Endogenous:
- Alpha1-antitrypsin deficiency
- Antibody deficiency syndrome
What is the pathophysiology of emphysema?
Abnormal permanent enlargement of the airspaces distal to terminal bronchioles + destruction of their walls without interstitial fibrosis –> results in trapping of air in dilated airspaces and loss of elastic recoil
- Repeated damage to alveoli acini
- Chronic inflammation from inhaled particules
- Imbalance of protease/anti-protease activity from alpha1-antitrypsin deficienccy
What is the pathophysiology of chronic bronchitis?
Chronic irritation (smoking, pollution) leads to hypersecretion of mucous in larger airways with subsequent inflammation of bronchi + bronchioles
- Mucous gland hypertrophy and hyperplasia
What is the clinical presentation of COPD in general?
COPD In General:
- Age of onset >35
- Smoking or pollution related
- Chronic dyspnoea
- Sputum production
- Minimal diurnal variation
- Wheeze
What is the clinical presentation of emphysema?
Progressive dyspnoea
Barrel chest
Wheezing
Cough if associated with chronic bronchitis
What is the clinical presentation of chronic bronchitis?
Dyspnoea
Cough with sputum production
What are the signs of COPD?
- Tachypnoea, respiratory distress- use of accessory muscles
- Hyper-inflation (barrel chest)
- Advanced COPD =clubbing
- Reduced chest expansion
- Hyper-resonant on percussion
- Quiet breath sounds
- Wheeze
- Cyanosis
- Cor pulmonale
What are the signs of cor pulmonale?
Cyanosis
Increased JVP
Crackles
Oedema
What Ix do you do when you suspect COPD?
Bedside:
Spirometry:
- Obstructive: FEV1 <80%, FEV1/FVC <0.7, increased RV, increased TLC, not reversible
- ECG: RA/RV hypertrophy
Labs:
- ABG: hypoxia +/- hypercapnia
- Sputum MCS
Imaging:
- CXR: hyperinflation, barrel chest, flat hemidiaphragms, decreased vascular markings, bullae
- CT: bronchial wall thickening, scarring, air space dilation
What is the management of COPD?
- Stop smoking
- Pneumococcal + influenza vaccination
- Pul rehab
- Physical activity
SABA as needed
1. LABA
2. LABA + ICS
What are some complications of COPD?
Acute infectious exacerbations
Pneumothorax
Respiratory failure
Cor pulmonale
