Clinical Features and Management of COPD Flashcards
What causes airway obstruction in COPD?
Small airway narrowing
What endogenous substances and responses can make small airway narrowing worse?
Mucous and inflammation
What does worsening of airway narrowing resulting in?
- Breathlessness on less exertion
- Coughing
- Wheeze
What is the gender predominance of COPD?
- Male more than female
What is the relationship between income and COPD?
Lower income households have a higher prevalence
How does COPD impact NHS?
- Increasing prevalence
- GP hours
- Hospital beds
What percentage of total COPD cases are linked to smoking?
85%
How does maternal smoking contribute to COPD?
- Reduces FEV1
- Increases chances of IRDS
What occupations are associated with COPD?
- Mining
- Tunnel working
- Construction
- Farming
- Any occupation involving exposure to dust
What is the function of a1 antitrypsin?
Neutralise enzymes released by neutrophils
What is the normal genotype for functioning a1 antitrypsin?
FiMM
What is the abnormal genotype for a1 antitrypsin?
PiZZ
How many years do you have to smoke a pack a day to typically have smoking related COPD?
20 years
What conditions are involved in the differential diagnosis of COPD?
- Asthma
- Lung cancer
- Left ventricular failure
- Fibrosing alveolitis
- Bronchiectasis
- TB
- PE
How should a diagnosis of COPD be done?
- Eliminate all other possible diagnoses first
What symptom differs asthma from COPD?
- Asthma is a variable obstruction
What systemic symptoms may a patient with COPD present with?
- Cachexia
- Peripheral Oedema
What other conditions should be considered if haemoptysis occurs?
- Lung cancer
- TB
- Bronchiectasis
What does peripheral oedema suggest?
- Cor pulmonale
- Severe disease
- Resp failure
With an adult with COPD, what might show in their childhood medical history?
Childhood asthma
What heart condition commonly shows in the PMH of a person with COPD?
Ischaemic heart disease
What is important when taking a drug history of someone with suspected COPD?
- Any inhalers
- Previous medications which may effect breathing
What are the clinical SIGNS of typical COPD?
- Breathlessness
- Pursed lip breathing
- Accessory breathing
- Cyanosis
- Flapping tremor
Investigations needed before COPD diagnosis?
- Spirometry
- Full pulmonary function test
- Lung volumes
- CO gas transfer
- Reversibility of obstruction from bronchodilators and oral corticosteroids
After initial investigations rule out asthma, what other investigations could be done?
- Chest x ray
- Blood gases
- FBC
- ECG
- Sputum
If FEV1 is normal what does it indicate with regards to COPD?
It rules it out
What spirometry results would indicate COPD?
FEV1/FVC ratio less than 70%
What chronic obstructive condition are you looking for when doing a pulmonary full functionality test?
Emphysema
What can be seen from doing spirometry?
Fixed airflow obstruction
What should happen to a patient with COPD in response to bronchodilators?
Minimal to no help
What should happen to a patient with COPD in response to oral corticosteroids?
Minimal to no help
If a suspected COPD sufferer responds to bronchodilators/oral corticosteroids what is probably going to be the diagnosis?
Asthma
What may be seen on a chest X ray of a COPD sufferer?
- Hyperinflated lungs
- Flattened diaphragm
- Bulla
What do chest x rays help diagnose if it isn’t COPD?
- Cancer
- Interstitial disease
- Left ventricle failure
What does a decreased PaO2 and normal PaCO2 indicate?
Type 1 respiratory failure
What does a decreased PaO2 and increased PaCO2 indicate?
Type 2 respiratory failure
What is the condition called that means a high level of RBC’s and will be shown by a FBC?
Polycytheamia
What might be found on a sputum test (MC&S)?
- Streptococcus pneumoniae
- Haemophilus Influenzae
- Moraxella Catarrhalis
What CONDITIONS can cause an acute exacerbation of COPD symptoms?
- Viral/bacterial infection
- Pneumothorax
- Trauma
How should acute exacerbations of COPD be managed?
- B2 bronchodilators
- O2
- Oral corticosteroids
- Antibiotics
- Diuretics
- Resp. stimulant
What is smoking cessation?
Quitting smoking
What is the aim of smoking cessation?
Prevention of progression of disease
What NHS management methods are there for COPD?
- Inhalers
- Vaccines
- Rehabilitation
- Long term oxygen therapy
What lifestyle management methods are available?
- Smoking cessation
- Nutritional changes
What inhaled therapy options are there to relieve symptoms?
- Short and long acting bronchodilators
- High dose corticosteroids
2 examples of short acting bronchodilators?
- Salbutamol
- Ipratropium
2 examples of long acting bronchodilators
- Umeclidinium (long acting anti-muscarinic agent)
- Salmeterol (long acting B2 agonist)
2 examples of high dose inhaled corticosteroids?
- Relvar
- Fostair MDI
When is long term oxygen used?
- PaO2 <7.3kPa
- Normal PaO2 but with polycythaemia, sleep apnea, peripheral oedema or pulmonary hypertension
When should hospital admission of AECOPD be considered?
- Tachypnoea
- Low sats
- Hypotension
What steroid treatment is standard for AECOPD?
Prednisolone 40mg per day for a week
How should AECOPD patients on the ward be monitored?
- Try get sats to 92%
- Nebulised bronchodilators
- Corticosteroids
- Antibiotics
