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Respiratory Y1 > Chronic Obstructive Pulmonary Disease (COPD) > Flashcards

Chronic Obstructive Pulmonary Disease (COPD) Flashcards

1
Q

describe COPD

A
  • chronic obstructive pulmonary disease
  • non reversible long term deterioration in air flow through lungs due to chronic damage to airways and/or lungs
  • difficulty expiring
  • difficulty in ventilation makes lungs more prone to infections
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2
Q

what is the main cause of COPD

A

smoking

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3
Q

what triggers exacerbations of COPD in Px

A

triggered by infections (called infective exacerbations)

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4
Q

what makes COPD different from asthma

A
  • obstruction not significantly reversible w/ bronchodilators
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5
Q

how might COPD present

A

(in a long term smoker)

  • chronic SoB
  • cough
  • sputum production
  • wheeze
  • recurrent resp infections esp in winter
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6
Q

what symptoms or not typically seen in COPD

A
  • doesn’t cause finger clubbing
  • haemoptysis
  • chest pain
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7
Q

give some differential diagnoses for a Px presenting w/ symptoms of COPD

A
  • lung cancer
  • fibrosis
  • HF
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8
Q

what is the MRC (medical research council) Dyspnoea Scale

A

5 point scale recommended by NICE for assessing the impact of breathlessness

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9
Q

describe the grades in MRC Dyspnoea Scale

A
  • Grade 1 - SoB on strenuous exercise
  • Grade 2 - SoB walking up hill
  • Grade 3 - SoB slows walking on flat
  • Grade 4 - stop to catch breath after walking 100m on flat
  • Grade 5 - unable to leave house due to SoB
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10
Q

what 2 things are typically used to diagnose COPD

A

clinical presentation and spirometry

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11
Q

describe the results of spirometry in COPD

A
  • gives obstructive picture

- FEV1:FVC ratio <75%

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12
Q

how can severity of airflow obstruction be assessed

A

graded using FEV1

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13
Q

describe the grades of severity in airway obstruction

A
  • Stage 1: FEV1 >80% of predicted
  • Stage 2: FEV1 50-79% of predicted
  • Stage 3: FEV1 30-49% of predicted
  • Stage 4: FEV1 <30% of predicted
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14
Q

what other investigations can be done to help with diagnosis and management of COPD or to exclude other conditions

A
  • CXR
  • FBC
  • BMI
  • sputum culture
  • ECG and echo-cg
  • CT thorax
  • serum alpha-1 antitrypsin
  • transfer factor for carbon monoxide (TLCO)
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15
Q

why might FBC be done when diagnosing COPD

A
  • to check for polycythaemia or anaemia

- polycythaemia (raised Hb) is a response to chronic hypoxia

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16
Q

why is serum alpha-1 antitrypsin tested for in suspected COPD

A
  • looking for deficiency

- deficiency leads to early onset and more severe disease

17
Q

why is transfer factor for carbon monoxide (TLCO) tested in suspected COPD

A
  • decreased in COPD
  • can give indication about severity of disease
  • may be ^ in other conditions e.g. asthma
18
Q

give an example of non pharmacological long term management of COPD

A

smoking cessation

19
Q

what vaccines should COPD Px receive

A
  • pneumococcal

- annual flu

20
Q

outline the pharmacological long term management of COPD

A

STEP 1
- SABA or SAMA

STEP 2
- if no asthmatic/steroid responsive features –> combined LABA and LAMA

  • if yes asthmatic/steroid responsive features –>
    combined LABA and LAMA plus inhaled corticosteroid (ICS)
21
Q

what pharmacological treatment options are available in more severe cases of COPD

A
  • nebulisers
  • oral theophylline
  • oral mucolytic therapy
  • long term prophylactic antibiotics
  • long term O2 therapy at home
22
Q

how might an exacerbation of COPD present

A

worsening of symptoms:

  • cough
  • SoB
  • sputum production
  • wheeze
23
Q

describe how might exacerbation of COPD affect arterial blood gas

A
  • acutely retaining CO2 –> carbonic acid –> blood more acidic
  • low pH w/ ^ pCO2
  • respiratory acidosis
24
Q

describe how chronic CO2 retention in COPD can be indicated

A
  • chronic CO2 retention indicated by ^ bicarbonate produced by kidneys to balance acidic CO2 and maintain normal pH
  • in acute exacerbation, kidneys can’t keep up w/ ^ CO2 so become acidotic despite having ^ bicarb
25
Q

outline how you can distinguish between the types of respiratory failure

A
  • low pO2 indicates hypoxia and resp failure
  • normal pCO2 w/ low pO2 indicates type 1 resp failure (only 1 lung affected)
  • raised pCO2 w/ low pO2 indicates type 2 resp failure (2 lungs affected)
26
Q

why is it important to carefully balance the amount of O2 given as O2 therapy to a COPD Px

A
  • too much O2 can depress resp drive
  • slows breathing rate and effort
  • leads them to retaining more CO2
27
Q

what type of mask is commonly used for O2 therapy in COPD Px

A

venturi mask

28
Q

what is the target O2 sats for a COPD Px retaining CO2 and what mask is used to achieve this

A

88-92% titrated by Venturi mask

29
Q

what is target O2 sats for a COPD Px that is not retaining CO2

A

> 94%

30
Q

outline the medical treatment for an exacerbation of COPD if Px well enough to stay at home

A
  • prednisolone 30mg once daily 7-14days
  • regular inhaler or home nebuliser
  • antibiotics if infection present
31
Q

outline the medical treatment for an exacerbation of COPD if Px in hospital

A
  • nebulised bronchodilators
  • steroids
  • antibiotics if infection present
  • physiotherapy to help clear sputum
32
Q

outline the medical treatment for an exacerbation of COPD in severe case where Px not responding to first line treatment

A
  • IV aminophylline
  • non invasive ventilation
  • intubation and ventilation w/ admission to intensive care
  • doxapram

Respiratory Y1 (14 decks)

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