Chronic Obstructive Pulmonary Disease Flashcards
What is COPD?
A progressive disorder characterised by airway obstruction with little or no reversibility
What is chronic bronchitis?
Cough with sputum production on most days for 3 months of 2 successive years
What is emphysema?
Enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls
What can cause COPD?
Smoking, air pollution
What is FEV1?
<80%
What is the FEV1:FVC?
<0.7
What factors would lead you to believe the patient has COPD and not asthma?
Older, smoking/pollution, chronic dyspnoea, sputum production, minimal FEV1 variation
What are some general symptoms of COPD?
Cough, sputum, dyspnoea, wheeze
What are some general signs of COPD?
Tachypnoea, accessory breathing, decreased expansion, quiet breath sounds, cyanosis
What might you see on a CXR?
Hyperinflation, flat hemidiaphragms, large and central pulmonary arteries
What might you see on a CT?
Bronchial wall thickening, scarring, air space enlargement
What might you see on an ECG?
Right heart hypertrophy
What might you see if you did blood gases?
Low oxygen, normal or high carbon dioxide
What might you see on spirometry?
Obstruction and air trapping
What are some differential diagnoses?
Asthma, congestive heart failure
What general management advice can you give?
Smoking cessation, exercise, mental health help
What might you need to start later that can help survival?
Long term oxygen therapy
What are some potential complications?
Acute exacerbations with/without infection, respiratory failure, cor pulmonale, pneumothorax, lung carcinoma
How is severity measured?
BODE index
What does BODE stand for?
BMI, Obstruction, Dyspnoea, Exercise capacity
How would you manage mild COPD?
Inhaled SAMA or inhaled SABA
How would you manage moderate COPD?
Inhaled LAMA or LABA
How would you manage severe COPD?
Add an inhaled steroid
Give an example of a SAMA
Ipratropium
Give an example of a SABA
Salbutamol
Give an example of a LAMA
Tiotropium
Give an example of a LABA
Formeterol
Give an example of an inhaled steroid
Symbicort - Budesonide + formeterol
What are the most common bacteria to cause infective exacerbations?
H. influenzae, S. pneumonia, Moraxella catarrhalis
Describe an exacerbation
Breathlessness, cough, bilateral expiratory wheeze
What should you start immediately in a COPD exacerbation?
Oxygen, salbutamol, ipratropium bromide
Why is an ABG important in a COPD exacerbation?
Establish need for BIPAP or referral to intensive care
