4) COPD Flashcards
Definition of COPD?
- Chronic, progressive airflow limitation with chronic inflammatory response
- FEV1 reduced, FEV1/FVC <0.7
What is chronic bronchitis?
Cough with sputum production for most days of 3 months for 2 years
What is emphysema?
Histological= enlarged air spaces distal to terminal bronchioles w/ destruction of alveolar walls
What is an exacerbation of COPD?
Acute, worsening of respiratory symptoms out of keeping with normal variability and will require a change in medication
Factors suggesting COPD over asthma?
- Age over 35
- Smoking
- Breathlessness chronic and progressive
- Sputum production
- Minimal diurnal/day to day variation
- No nightime waking
What is a pink puffer?
Increased alveolar ventilation, breathless but not hypoxic. At risk of T1 failure
What is a blue bloater?
decreased alveolar ventilation, hypoxic but not breathless. May get cor pulmonale, careful with o2 as hypoxic drive
Pathogenesis of COPD?
Increased oxidants and inflammation from chronic irritant gives increaased proteases. Combo of these 3 gives parenchymal tissue destruction, impaired defense and repair and increased luminal exudates
Signs and Symptoms of COPD?
Cough, sputum, dyspnoea, wheeze
Tacypnoea, accessory muscle use, hyperinflation, decreased cricosternal distance, cyanosis, cor pulmonale
COmplications of COPD?
Acute exacerbations, polycythaemia, resp failure, cor pulmonale, pneumothorax
Tests for COPD?
FBC: polycythaemia CXR: hyperinflation, bullae. decreased peripheral vascular markings ECG: RVH ABG: decreased PaO2 Lung Fx: Obstructive picture
Staging of COPD?
All have a FEV1/FVC of <0.7
Mild: FEV1 >80
Moderate: 50-79%
Severe: 30-49%
V Severe: <30%
When should you refer to specialist?
Uncertain on diagnosis Severe Cor pulmonale LTOT or steroid consideration Rapid decline Possible surgery Young and need a1antitrypsin excluded Lots of infections (?bronchiectasis) Haemoptysis
Managing stable COPD? (broad strategies)
1) STOP SMOKING, encourage exercise, treat poor nutrition
2) Inhaled therapy
3) Pulmonary rehab where appropriate
4) Manage any depression
5) Mucolytics may help
Stepwise pharmaceutical management of COPD?
1) SABA or SAMA as required
2) if FEV1 > 50% then LABA or LAMA
if FEV1< 50% then LABA+ICS or LAMA
3) if on LABA and deteriorates then LABA +ICS
if failure go to triple therapy
4) Long term corticosteroids (only if hard to wean them off post exac)
