Chronic obstructive pulmonary disease (COPD) Flashcards
Define COPD
Chronic, progressive lung disorder characterised by airflow obstruction, with chronic bronchitis & emphysema
Define chronic bronchitis
chronic cough & sputum production on most days for at least 3 months per year over 2 consecutive years
Define emphysema
pathological diagnosis of permanent destructive enlargement of air spaces distal to terminal bronchioles
Aetiology of COPD
2
Bronchial & alveolar damage is caused by environmental toxins (e.g. cigarette smoke)
RARE cause - α1 antitrypsin deficiency (consider in young people who don’t smoke)
Aetiology of chronic bronchitis
4
Narrowing of the airways resulting in bronchiole inflammation (bronchiolitis)
Bronchial mucosal oedema
Mucous hypersecretion
Squamous metaplasia
Aetiology of emphysema
3
Destruction & enlargement of alveoli
Leads to loss of elasticity that keeps small airways open in expiration
Progressively larger spaces develop called bullae (diameter > 1cm)
Epidemiology of COPD
prevalence, age, gender
VERY COMMON (8% prevalence)
Presents in middle age or earlier
More common in males
Presenting symptoms of COPD
5
Chronic cough Sputum production Breathlessness Wheeze Reduced exercise tolerance
Signs of COPD on physical examination - inspection
5
Respiratory distress Use of accessory muscles Barrel-shaped over inflated chest Decreased cricosternal distance Cyanosis
Signs of COPD on physical examination - percussion
2
Hyper resonant chest
Loss of liver & cardiac dullness
Signs of COPD on physical examination - auscultation
5
Quiet breath sounds Prolonged expiration Wheeze Rhonchi Sometimes crepitations
Signs of COPD on physical examination - CO2 retention
3 + 3 late stages
Bounding pulse
Warm peripheries
Asterixis
LATE stages: Signs of heart failure right ventricular heave raised JVP ankle oedema
Investigations for COPD
7 types
Spirometry & pulmonary function tests CXR Bloods ABG ECG & echocardiogram Sputum & blood cultures α1 antitrypsin levels
Investigations for COPD - spirometry & pulmonary function tests
(4)
Shows obstructive picture - Reduced PEFR Reduced FEV1/FVC Increased lung volumes Decreased CO gas transfer coefficient
Investigations for COPD - CXR
4
May appear NORMAL
Hyperinflation - >6 anterior ribs, flattened diaphragm
Reduced peripheral lung markings
Elongated cardiac silhouette
Investigations for COPD - bloods
FBC - increased Hb & haematocrit due to secondary polycythaemia
Investigations for COPD - ABG
may show hypoxia, normal/raised PCO2
Investigations for COPD - ECG & echocardiogram
check for heart failure
Investigations for COPD - sputum & blood cultures
for infective exacerbations
Investigations for COPD - α1 antitrypsin levels
in young patients who gave never smoked
Management of COPD
7 aspects
STOP SMOKING
Bronchodilators
Steroids
Pulmonary rehabilitation
Oxygen therapy
Treatment of acute exacerbation
Prevention of infective exacerbations
Management of COPD - bronchodilators
3
Short acting β2 agonists - e.g. salbutamol
Anticholinergics - e.g. ipratropium bromide
Long acting β2 agonists (if >2 exacerbations per year)
Management of COPD - steroids
2
Inhaled beclomethasone - if FEV1 < 50% predicted OR >2 exacerbations per year
Regular oral steroid should be avoided if possible
Management of COPD - oxygen therapy
3
Only if stopped smoking
Indicated if:
PaO2 < 7.3 kPa on air during period of clinical stability
PaO2 7.3-8 kPa & signs of secondary polycythaemia, nocturnal hypoxaemia, peripheral oedema or pulmonary hypertension
