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Year 3 Respiratory > COPD > Flashcards

COPD Flashcards

1
Q

COPD

A

Chronic bronchitis and emphysema

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2
Q

Causes

A

Smoking
Pollution
Young pt - α1 - anti trypsin disease

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3
Q

Signs of COPD

A

Airway obstruction: FEV1 <80%, FEV1:FVC <0.70

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4
Q

Chronic bronchitis

A

Inflammation of bronchi
Cough and sputum production on
most days for 3mo of 2 successive years

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5
Q

Emphysema

A

Destruction of elastin fibres causing destruction of alveolar walls and enlarged air spaces

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6
Q

Symptoms

A

Cough + sputum
Dyspnoea
Wheeze

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7
Q

Signs

A

Tachypnoea

Use of accessory muscles

Hyperinflation - barrel chest

Displaced liver edge

Wheeze

Cyanosis

Cor pulmonale: ↑JVP, oedema, loud P2

Cough

Plethoric complexion

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8
Q

Pink puffers - emphysema

A

↑ alveolar ventilation → breathless but not cyanosed

Progress → T1 respiratory failure

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9
Q

Blue Bloaters in chronic Bronchitis

A

↓ alveolar ventilation → cyanosed but not breathless
↓PaO2 and ↑ PaCO2: rely on hypoxic drive

Progress → T2 respiratory failure and cor pulmonale

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10
Q

nMRC Dyspnoea Score

A
  1. Normal
  2. SOB on hurrying or walking up stairs
  3. Walks slowly or has to stop for breath
  4. Stops for breath after <100m
  5. Too breathless to leave house or SOB on dressing
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11
Q

Complications

A 
Acute exacerbations ± infection
Polycythaemia
Pneumothorax (ruptured bullae)
Cor Pulmonale
Lung carcinoma
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12
Q

Ix

A 
A-E
Respiratory examination 
Basic obs 
Bloods: FBC (polycythaemia), α1-AT level
ABG
CXR
Spirometry
Sputum culture
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13
Q

Signs on CXR

A

Hyperinflation (> 6 ribs anteriorly)

Barrel chest

Flattened diaphragm

Reduced cricosternal distance

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14
Q

Spirometry

A

FEV1:FVC <0.70
Does not get better with bronchodilators

  • Scalloping - flow volume loop
  • ↑TLC, ↑RV
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15
Q

Assess severity

A

Mild: FEV1 >80% (but FEV/FVC <0.7 and symptomatic)
Mod: FEV1 50-79%
Severe: FEV1 30-49%
Very Severe: FEV1 < 30%

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16
Q

General Mx

A 
Stop smoking
Pulmonary rehabilitation / exercise
Screen and Mx comorbidities
Influenza and pneumococcal vaccine
Review 1-2x/yr
17
Q

Mx

A

ICS + SABA
+ LAMA
+ Long term oxygen therapy

18
Q

Long term oxygen therapy

A

Aim: PaO2 ≥8 for ≥15h / day

- Terminally ill pts.

19
Q

Mx of acute exacerbation of COPD

A
  1. Sit up
  2. Oxygen therapy - 88 - 92%
  3. Nebulised salbutamol
  4. Ipratropium
  5. Prednisolone 30mg OD for 5 or hydrocortisone IV if NBM
  6. Abx if infective - amoxicillin, clarithromycin or doxycycline
  7. NIV if no response
  8. Consider aminophylline IV
20
Q

NIV BiPAP

A

Breathing support delivering air, via a facemask by positive pressure

Inspiratory positive airways pressure (iPAP) is higher than the expiratory positive airways pressure

Aids inspiration and expiration

21
Q

CPAP

A

Constant fixed positive pressure

22
Q

Acute exacerbation of COPD

A 
Worsening dyspnoea 
Productive cough
Wheeze 
URTI in last 5 days 
Fever
23
Q

Severe COPD

A 
Tachypnoea 
Pursed lip breathing 
Accessory muscles 
New onset cyanosis 
Drowsiness 
Marked reduction in activities of daily living
24
Q

Admission criteria

A 
Severe breathlessness 
Inability to cope at home 
Rapid onset 
Acute confusion or impaired consciousness 
Cyanosis
SpO2 < 90%
Worsening peripheral oedema 
New arrhythmia 
Already on long term oxygen therapy 
Failure to respond to initial treatment
25
Q

Chronic management

A

SMOKING CESSATION
Physiotherapy and breathing techniques
Pneumococcal and influenza vaccine
Inhaler - SABA/SAMA

26
Q

Pharmacological management

A
  1. SABA/ SAMA
  2. LABA/ LAMA - if non asthmatic features (discontinue SAMA)
  3. ICS
  4. LABA and ICS - asthmatic and steroid responsive
  5. LAMA

Azithromycin -prophylaxis to reduce risk of exacerbations in pts who are non smokers and have optimal treatment with frequent exacerbation (4+

27
Q

Severity according to FEV1

A

> 80 - mild

50 - 79 - moderate

30 - 49 - severe

< 30 - very severe

28
Q

Causative organisms of infective exacerbation

A

Haemophilus influenzae
Streptococcus pneumoniae
Moraxella catarrhalis

29
Q

When to give long term oxygen therapy

A

Doesn’t smoke
Not a CO2 retainer
PaO2 < 7.3

Year 3 Respiratory (13 decks)

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