Chronic obstructive pulmonary disease Flashcards
COPD
Non-reversible, long term deterioration in air flow through lungs
Almost always the result of smoking
Features
Dyspnoea
Cough- often productive
Wheeze
In severe cases right sided heart failure may develop resulting in peripheral oedema
Dyspnoea scale
1- breathlessness on strenuous exercise
2- breathlessness on walking up hill
3- breathless that slows walking on the flat
4- stop to catch their breath after walking 100m on the flat
5- unable to leave house due to breathlessness
Investigations
Post-bronchodilator spirometry demononstrates airflow obstruction (FEV1:FVC <70%)
Chest xray
- hyperinflation
- bullae
- flat hemidiaphragm
- exclude lung cancer
FBC to exclude secondary polycythaemia
BMI
Severity
Stage 1 (mild): FEV1:FVC <70%, FEV1 >80%
Stage 2 (moderate): FEV1:FVC <70%, FEV1 50-79%
Stage 3 (severe): FEV1:FVC <70%, FEV1 30-49%
Stage 4 (very severe): FEV1:FVC <70%, FEV1 <30%
General management
Smoking cessation advice
Annual influenza vaccination
One-off pneumococcal vaccination
Pulmonary rehabilitation if functionally disabled by COPD
1st line treatment
SABA (salbutamol or terbatuline) or SAMA (ipratropium bromide)
Step 2
No asthmatic or steroid responsive features
- LABA + LAMA
Asthmatic or steroid responsive features
- LABA + ICS
Step up to LABA + LAMA + ICS
Additional options
Nebulisers
Oral theophylline
Oral mucolytic therapy
Long term prophylactic antibiotics
Long term oxygen therapy at home
Asthmatic/ steroid responsive features
Previous, secure diagnosis of asthma or atopy
Higher blood eosinophil count
Substantial variation in FEV1 over time
Substantial diurnal variation in peak expiratory flow
Causes of infective exacerbations
Bacteria: haemophilus influenzae (most common), streptococcus pneumoniae, moraxella catarrhalis
Respiratory viruses: 30% of exacerbations, human rhinovirus most important
Features of acute exacerbations
Increase in dyspnoea, cough, wheeze
Increase in sputum suggestive of infective cause
May be hypoxic and have acute confusion
ABG
Low pH with raised pCO2 suggest acutely retaining (respiratory acidosis)
Raised bicarbonate indicates chronically retaining CO2
Treatment of exacerbation at home
Prednisolone 30mg OD 7-14days
Regular inhalers or home nebulisers
Antibiotics if evidence of infection
Treatment of exacerbation in hospital
Nebulised bronchodilators
Steroids
Antibiotics if infection
Physiotherapy to help clear sputum