Chronic Obstructive Pulmonary Disease Flashcards
COPD
Chronic, progressive respiratory condition characterised by obstruction, bronchitis, and emphysema.
Non-reversible.
Chronic bronchitis
- characteristic feature of COPD
- chronic cough
- sputum production
- ‘blue bloater’
Emphysema
- Damaged and dilatation of alveoli
- reduced elasticity and surface area
- ‘pink puffer’ purse lip breathing
- barrel chest
Clinical features of COPD
- dyspnoea
- wheeze
- productive cough
- recurrent chest infections
Gold standard investigation for COPD
Spirometry
- FEV1:FVC < 0.7
- +/- reduced FEV1(predicted)
Chest x-ray findings in COPD
- lung hyperinflation
- flattened diaphragm
Potential FBC findings in COPD
- reduced RBCs = polycythaemia
polycythaemia
- low red blood cells (Hb)
- indicates chronic hypoxia
- often seen in COPD
Determining severity of COPD
- Spirometry (FEV1% predicted)
- MRC dyspnoea scale (grade 1-5)
Staging severity of COPD
FEV1 % predicted
Stage 1: Mild (> 80%)
Stage 2: Moderate (50-79%)
Stage 3: Severe (30-49%)
Stage 4: Very severe (< 30%)
General management of COPD
- smoking cessation
- vaccinations
- pulmonary rehabilitation
- medication
Medical management of COPD
First presentation
SABA (salbutamol) or SAMA (ipratropium bromide)
Medical management of COPD
Not managed with SABA/SAMA, no asthmatic features
Add LABA & LAMA
Medical management of COPD
Not managed with SABA/SAMA, asthmatic features present
Add LAMA & ICS
Medical management of COPD
Not managed with SABA/SAMA, LABA/LAMA/ICS
Triple therapy
LABA + LAMA + ICS
Trimbow
Medical management of COPD
Not controlled on maximum medical therapy
Add in prophylactic antibiotic
Azithromycin
Complications of COPD
- cor pulmonale
- acute (infective) exacerbations
Cor pulmonale
Right sided heart failure
Most common causes of cor pulmonale
- COPD
- PE
- Interstitial lung diseases
- Cystic fibrosis
- Primary pulmonary hypertension
Clinical features of cor pulmonale
- SOB
- peripheral oedema
- chest pain
- syncope
Examination findings in cor pulmonale
- hypoxia, cyanosis
- raised JVP
- loud P2, parasternal heave
- hepatomegaly
ABG findings in acute exacerbation of COPD
Respiratory acidosis
reduced O2, raised CO2, raised HCO3 (from chronic hypercapnia)
Managing acute exacerbation of COPD
- O2 therapy (88-92%)
- Medical (inhalers, steroids, abs)
- Non-invasive ventilation
Antibiotics used in acute exacerbation of COPD
- amoxicillin
- doxycyclin
Main cause of infective exacerbation of COPD
Haemophillus pneumoniae
