Chronic obstructive pulmonary disease (COPD) Flashcards
1) What is COPD?
2) What 2 conditions does it comprise of?
1) Irreversible, long term deterioration in air flow through the lungs caused by damage to lung tissue
2) Chronic bronchitis, emphysema
1) How is emphysema defined histologically?
2) How is chronic bronchitis defined clinically?
1) Enlarged air spaces distal to the terminal bronchioles with destruction of alveolar walls
2) Cough with sputum production most days for 3 months of 2 successive years
Name 3 ways a patient with COPD may present
- Long term smoker
- Shortness of breath/dyspnoea
- Sputum producing cough
- Wheeze
- Recurrent respiratory infections especially in winter
Name a symptom that’s normally associated with respiratory pathology but is NOT associated with COPD
- Clubbing
- Haemoptysis
- Chest pain
1) Name 2 features of emphysema
2) Name 2 features of chronic bronchitis
3) What type of respiratory failure might emphysema progress to?
4) What condition may chronic bronchitis progress to?
5) What do patients with chronic bronchitis rely on to maintain respiratory effort
6) What is the clinical relevance of this?
1) Increased alveolar ventilation, near normal PaO2, normal or low PaCo2, breathless, not cyanosed
2) Decreased alveolar ventilation, low PaO2, high PaCo2, not breathless but are cyanosed
3) Type 1
4) Cor pulmonale
5) Hypoxic drive
6) Supplemental oxygen should be given with care
How is COPD diagnosed?
Spirometry (FEV1/FVC ratio <0.7) shows an obstructive picture.
Reversibility testing (spirometry after beta2 agonist) would show no significant change from before or after beta2 agonist
Long term management of COPD (1)
1) What 2 things are important in the management of COPD before medication?
2) What is the 1st step in the medical management of COPD (2)?
3) What is the 2nd step in the medical management of COPD (2)?
4) When should the management of the second step change, and to what should it be changed to in this case?
1) Smoking cessation and pneumococcal and flu vaccine
2) Short acting beta2 agonist (salbutamol) or short acting antimuscarinic (ipratropium bromide)
3) Combined long acting beta2 agonist and long acting antimuscarinic
4) If the patient has asthmatic/steroid responsive symptoms. Medication should be changed to a LABA and an inhaled corticosteroid
Long term management of COPD (2)
1) Name 2 options for the management of more severe cases
2) Name 2 problems caused by COPD that results in the use of long term oxygen therapy
1) Nebulisers (salbutamol or ipratropium), oral theophylline, oral mucolytic therapy to break down sputum (i.e. carbocisteine), long term prophylactic antibiotics, long term oxygen therapy at home
2) Chronic hypoxia, polycythemia, cyanosis, HF secondary to cor pulmonale
Oxygen therapy in COPD
1) Why is it dangerous to give too much oxygen therapy to someone that is prone to retaining oxygen?
2) What masks are designed to deliver a specific percentage concentration of oxygen?
1) It can lower their respiratory drive leading to a lower breathing rate and increased retention of CO2
2) Venturi mask
Exacerbation of COPD (1)
1) What is the commonest cause of an infective COPD exacerbation?
2) What effect is seen on PaCO2 and PaO2 in type I respiratory failure?
3) What effect is seen on PaCO2 and PaO2 in type II respiratory failure?
1) H. Influenzae
2) PaCO2 normal, PaO2 low
3) PaCO2 raised, PaO2 low
Exacerbation of COPD (2)
1) If at home, how is an exacerbation of COPD managed (3)?
2) If at the hospital, how is an exacerbation of COPD managed (4)?
3) Name 2 options in severe cases where there’s no response to the 1st line treatment
1) Prednisolone, regular inhalers or home nebulisers and antibiotics if there is evidence of infection
2) Nebulised bronchodilators, steroids, antibiotics if evidence of infection and physiotherapy to help clear sputum
3) IV aminophylline, non-invasive ventilation,
intubation and ventilation with admission to intensive care, doxapram can be used as a respiratory stimulant
Patients with severe COPD who remain breathless despite maximal medical therapy should be considered for what type of surgery?
Lung volume reduction surgery
Name 3 of the 4 indications for the surgical treatment of COPD (apart from remaining breathless despite maximal medical therapy)
- Predominantly upper lobe emphysema
- FEV1 >20% predicted
- PaO2 < 7.3 kPa
- TLCO >20% predicted
When should NIV be considered in the management of a patient with an acute COPD exacerbation?
Maximal medical treatment and persisting respiratory acidosis
Name 3 scenarios where an assessment of whether LTOT is necessary is done
- Very severe airflow obstruction (FEV1 < 30% predicted)
- Cyanosis
- Polycythaemia
- Peripheral oedema
- O2 sats <92% OA
- Raised JVP
