COPD Flashcards
COPD
Chronic bronchitis and emphysema
Causes
Smoking
Pollution
Young pt - α1 - anti trypsin disease
Signs of COPD
Airway obstruction: FEV1 <80%, FEV1:FVC <0.70
Chronic bronchitis
Inflammation of bronchi
Cough and sputum production on
most days for 3mo of 2 successive years
Emphysema
Destruction of elastin fibres causing destruction of alveolar walls and enlarged air spaces
Symptoms
Cough + sputum
Dyspnoea
Wheeze
Signs
Tachypnoea
Use of accessory muscles
Hyperinflation - barrel chest
Displaced liver edge
Wheeze
Cyanosis
Cor pulmonale: ↑JVP, oedema, loud P2
Cough
Plethoric complexion
Pink puffers - emphysema
↑ alveolar ventilation → breathless but not cyanosed
Progress → T1 respiratory failure
Blue Bloaters in chronic Bronchitis
↓ alveolar ventilation → cyanosed but not breathless
↓PaO2 and ↑ PaCO2: rely on hypoxic drive
Progress → T2 respiratory failure and cor pulmonale
nMRC Dyspnoea Score
- Normal
- SOB on hurrying or walking up stairs
- Walks slowly or has to stop for breath
- Stops for breath after <100m
- Too breathless to leave house or SOB on dressing
Complications
Acute exacerbations ± infection Polycythaemia Pneumothorax (ruptured bullae) Cor Pulmonale Lung carcinoma
Ix
A-E Respiratory examination Basic obs Bloods: FBC (polycythaemia), α1-AT level ABG CXR Spirometry Sputum culture
Signs on CXR
Hyperinflation (> 6 ribs anteriorly)
Barrel chest
Flattened diaphragm
Reduced cricosternal distance
Spirometry
FEV1:FVC <0.70
Does not get better with bronchodilators
- Scalloping - flow volume loop
- ↑TLC, ↑RV
Assess severity
Mild: FEV1 >80% (but FEV/FVC <0.7 and symptomatic)
Mod: FEV1 50-79%
Severe: FEV1 30-49%
Very Severe: FEV1 < 30%
General Mx
Stop smoking Pulmonary rehabilitation / exercise Screen and Mx comorbidities Influenza and pneumococcal vaccine Review 1-2x/yr
Mx
ICS + SABA
+ LAMA
+ Long term oxygen therapy
Long term oxygen therapy
Aim: PaO2 ≥8 for ≥15h / day
- Terminally ill pts.
Mx of acute exacerbation of COPD
- Sit up
- Oxygen therapy - 88 - 92%
- Nebulised salbutamol
- Ipratropium
- Prednisolone 30mg OD for 5 or hydrocortisone IV if NBM
- Abx if infective - amoxicillin, clarithromycin or doxycycline
- NIV if no response
- Consider aminophylline IV
NIV BiPAP
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
CPAP
Constant fixed positive pressure
Acute exacerbation of COPD
Worsening dyspnoea Productive cough Wheeze URTI in last 5 days Fever
Severe COPD
Tachypnoea Pursed lip breathing Accessory muscles New onset cyanosis Drowsiness Marked reduction in activities of daily living
Admission criteria
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
Chronic management
SMOKING CESSATION
Physiotherapy and breathing techniques
Pneumococcal and influenza vaccine
Inhaler - SABA/SAMA
Pharmacological management
- SABA/ SAMA
- LABA/ LAMA - if non asthmatic features (discontinue SAMA)
- ICS
- LABA and ICS - asthmatic and steroid responsive
- LAMA
Azithromycin -prophylaxis to reduce risk of exacerbations in pts who are non smokers and have optimal treatment with frequent exacerbation (4+
Severity according to FEV1
> 80 - mild
50 - 79 - moderate
30 - 49 - severe
< 30 - very severe
Causative organisms of infective exacerbation
Haemophilus influenzae
Streptococcus pneumoniae
Moraxella catarrhalis
When to give long term oxygen therapy
Doesn’t smoke
Not a CO2 retainer
PaO2 < 7.3
