Chronic obstructive pulmonary disease Flashcards
What do these results show?
Obstructive pattern of spirometry
Prolonged expiratory phase
What do these imaging results show?
Hyperexpanded lungs
Flattening of diaphragm
Chronic changes at bases
What do these imaging results show?
Absense of normal lung
Bulla (holes) - alveolar destruction typical of emphysema
What is COPD?
Preventable and treatable disease characterised by persistent, progressive airflow limitation (not fully reversible)
Enhanced chronic inflammatory response in the lungs to noxious gases/particles
Why is there a rising prevelance of COPD?
Due to ageing population
Complete the diagram on how COPD develops
What are the 3 features of COPD?
What is the pathophysiology of COPD in the airways?
Chronic inflammation
Increased number of goblet cells
Mucus cell hyperplasia
Fibrosis
Narrowing and reduction in the number of small airways
Airway collapse due to alveolar wall destruction in emphysema
What is chronic bronchitis?
- Chronic Bronchitis (large airways)
Chronic productive cough for three months in two successive years
Exclude other causes of chronic cough
What is emphysema?
EMPHYSEMA (Alveolar)
Abnormal and permanent enlargement of the airspaces due to destruction of the alveolar airspace walls
Effects gas exchange
What is small airways disease?
SMALL AIRWAYS disease
Wheeze
What does this CT show?
Massive bulla
What are the risk factors for COPD?
How does a doctor take a smoking history?
Age started
Calculate pack year history
Times stopped and why failed quit attempt
Recreational drugs smoked (or other substances eg shisha)
Complete the diagram on the consequences of COPD
How is COPD diagnosed?
Symptoms (exertional breathlessness, productive cough, “winter bronchitis”, wheeze) + Risk factors (10 pkyr smoking history and age>35 years) + spirometry (FEV1/FVC <0.7)
Draw what a flow-volume loop would look like in COPD
How is there severity of COPD determined?
What are the physical signs of COPD?
Barrel-shaped chest
(hyperresonant) percussion
Accessory muscles
Prolonged expiration
Pursed-lip breathing
Tripod position
Low BMI
Nicotine-staining
What are the physiological effects of COPD?
Increased work of breathing
Reduced Exercise Tolerance
Impaired gas exchange
- Hypoxia
- Hypercapnia
- Raised pulmonary artery pressure
- RV dilatation, cor pulmonale
- Loss of Fat Free Mass
How is chronic COPD managed?
- Stop smoking
- If symptomatic LABA/LAMA combined inhaler (eg. Duaklir)
- Flu vaccination
- Educate and Empower
- Treat exacerbations
- Pulmonary rehabilitation
- Think about the whole patient (bones, nutrition, mental health)
- (LTOT)
What is pulmonary rehabilitation?
2x supervised sessions for 6 weeks
- Supervised exercise
- Education
- Psychosocial support/group work
What are the treatments for COPD?
- Theophylline (oral phosphodiesterase inhibitor)
- Azithromycin 3x/week (anti-inflammatory antibiotic prophylaxis)
- Lung volume reduction surgery (valves/bullectomy)
- Lung transplantation
What is an acute exacerbation?
Acute deterioration in symptoms requiring additional therapy
How are acute exacerbations treated?
Mild (SABA)
Moderate (SABA +/- steroids +/- antibiotics)
Severe (Hospital admission) or ED attendance
How would you treat this patient?
On assessment in ED she cannot speak in a full sentence so history taking is brief
RR 35
Oxygen saturations 83% on air, 90% on FiO2 0.28
Afebrile, CRP 22, WCC 13
Bp 130/70 PR 115 bpm
No chest pain, no haemoptysis, no peripheral oedema
Examination demonstrates scattered wheeze throughout her chest
- Antibiotics if signs of infection (sputa results)
- Oral steroids
- Target saturations 88-92% (controlled oxygen)
- Nebulisers (bronchodilate)
- Consider diuretics
- Nicotine replacement therapy/refer for smoking cessation
What is the diagnosis?
COPD patient
On assessment in ED she cannot speak in a full sentence so history taking is brief
RR 35
Oxygen saturations 83% on air, 90% on FiO2 0.28
Afebrile, CRP 22, WCC 13
Bp 130/70 PR 115 bpm
No chest pain, no haemoptysis, no peripheral oedema
Examination demonstrates scattered wheeze throughout her chest
ED attendance due to progressive dyspnoea/hypoxia or signs of infection or signs of right heart failure
Severe exacerbation
How can treatment fail?
- Decompensated hypercapnic respiratory failure despite controlled oxygen and nebulised treatmentsà Non-Invasive Ventilation
- Respiratory failure despite nebulised therapy and controlled oxygen and patient unable to tolerate NIVà Consider invasive mechanical ventilation
- Respiratory failure on background of significant progressive decline over several months/years with no evidence of reversible event à palliate
How can COPD symptoms be managed in palliative patients?
Oromorph
Lorazepam
Fan therapy
Oxygen therapy
CBT
Pacing/Breathing strategies
Hospice input
