Chronic obstructive pulmonary disease Flashcards

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1
Q

COPD

A

Non-reversible, long term deterioration in air flow through lungs

Almost always the result of smoking

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2
Q

Features

A

Dyspnoea

Cough- often productive

Wheeze

In severe cases right sided heart failure may develop resulting in peripheral oedema

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3
Q

Dyspnoea scale

A

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

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4
Q

Investigations

A

Post-bronchodilator spirometry demononstrates airflow obstruction (FEV1:FVC <70%)

Chest xray
- hyperinflation
- bullae
- flat hemidiaphragm
- exclude lung cancer

FBC to exclude secondary polycythaemia

BMI

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5
Q

Severity

A

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%

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6
Q

General management

A

Smoking cessation advice

Annual influenza vaccination

One-off pneumococcal vaccination

Pulmonary rehabilitation if functionally disabled by COPD

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7
Q

1st line treatment

A

SABA (salbutamol or terbatuline) or SAMA (ipratropium bromide)

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8
Q

Step 2

A

No asthmatic or steroid responsive features
- LABA + LAMA

Asthmatic or steroid responsive features
- LABA + ICS

Step up to LABA + LAMA + ICS

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9
Q

Additional options

A

Nebulisers

Oral theophylline

Oral mucolytic therapy

Long term prophylactic antibiotics

Long term oxygen therapy at home

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10
Q

Asthmatic/ steroid responsive features

A

Previous, secure diagnosis of asthma or atopy

Higher blood eosinophil count

Substantial variation in FEV1 over time

Substantial diurnal variation in peak expiratory flow

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11
Q

Causes of infective exacerbations

A

Bacteria: haemophilus influenzae (most common), streptococcus pneumoniae, moraxella catarrhalis

Respiratory viruses: 30% of exacerbations, human rhinovirus most important

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12
Q

Features of acute exacerbations

A

Increase in dyspnoea, cough, wheeze

Increase in sputum suggestive of infective cause

May be hypoxic and have acute confusion

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13
Q

ABG

A

Low pH with raised pCO2 suggest acutely retaining (respiratory acidosis)

Raised bicarbonate indicates chronically retaining CO2

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14
Q

Treatment of exacerbation at home

A

Prednisolone 30mg OD 7-14days

Regular inhalers or home nebulisers

Antibiotics if evidence of infection

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15
Q

Treatment of exacerbation in hospital

A

Nebulised bronchodilators

Steroids

Antibiotics if infection

Physiotherapy to help clear sputum

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16
Q

Other options in severe exacerbations

A

IV aminophylline

NIV

Intubation and ventilation

17
Q

Oxygen therapy

A

Too much oxygen can depress respiratory drive

Use venturi mask to deliver specific percentage concentration of oxygen

If retaining aim 88-92%

If not retaining aim normal >94%