COPD Flashcards
Define chronic bronchitis
Cough and sputum production on
most days for 3mo of 2 successive years.
Define emphysema
histological diagnosis of enlarged air
spaces distal to terminal bronchioles with destruction of
alveolar walls.
What is the spirometry pattern in COPD?
Airway obstruction: FEV1 <80%, FEV1:FVC <0.70
Four signs of COPD?
Tachypnoea Prolonged expiratory phase Hyperinflation Wheeze May have early-inspiratory crackles Cyanosis Cor pulmonale: ↑JVP, oedema, loud P2 Signs of steroid use
Two signs of hyperinflation?
displaced liver edge
loss of cardiac dullness
reduced cricosternal distance
What is the name of the dyspnoea scale that assesses impact of breathing in COPD?
MRC dyspnoea score/scale
Patient with COPD stops for breath <100m/few min. What is their MRC score?
4
- Dyspnoea only on vigorous exertion
- SOB on hurrying or walking up stairs
- Walks slowly or has to stop for breath
- Stops for breath after <100m / few min
- Too breathless to leave house or SOB on dressing
Three complications of COPD?
Acute exacerbations ± infection Polycythaemia Pneumothorax (ruptured bullae) Cor Pulmonale Lung carcinoma
Aside from spirometry, name three other investigations for COPD
CXR- rule out other pathology + see hyperinflation FBC Echo BMI ECG CT thorax Sputum culture Serum alpha1 antitrypsin
Which deficiency predisposes you to COPD?
alpha 1 antitrypsin
Which abnormality in FBC result might you see in COPD patient?
polycythaemia= raised Hb due to response to chronic hypoxia
Severity staging in COPD is based on which parameter?
FEV1
FEV1 60%. What is the severity stage of COPD?
Mod/stage 2
Mild/stage 1: FEV1 >80% (but FEV/FVC <0.7 and symptomatic)
Mod: FEV1 50-79%
Severe: FEV1 30-49%
Very Severe: FEV1 < 30%
Aside from pharmacological management, name three approaches to managing COPD
- Stop smoking
- Pulmonary rehab
- Influenza and pneumococcal vaccine
- Nutrition and reduce weight
COPD is only breathless upon exercise, which drug do you give them?
SABA and/or SAMA PRN
COPD patient has persistent breathlessness, what drug do you give them?
LABA + LAMA + ICS
Aside from inhalers, name one other pharmacological agent that can be prescribed for COPD?
mucolytic with productive cough= carbocisteine
Management of acute exacerbation of COPD?
similar protocol to acute asthma
Sit patient upright 24% venturi mask Salbutamol and ipratropium nebuliser IV steroids- hydrocortisone Abx if infection
Two modes of NIV?
BiPAP or CPAP
One contraindication to NIV?
pneumothorax or other structural abnormality, facial deformation
Two pressures applied in BiPAP?
IPAP- inspiratory, air forced into lungs
EPAP- expiratory, provides pressure during expiration so airways doen’t collapse
How should COPD exacerbation be monitored?
ABG after every hour if any treatment changes made.
ABG after every 4 hours until stable
Two indications for CPAP?
Obstructive sleep apnoea
Congestive cardiac failure
Acute pulmonary oedema
What are clinical features present in both COPD and HF progression?
wheeze, cough, SOB at rest, chest tightness, SOB on exertion, chronic symptoms
How to distinguish between COPD and heart failure?
HF- ankle swelling, positional, wake up gasping.
COPD- increased sputum production
Which cells are involved in COPD inflammation?
macrophages, CD8 and CD4 T lymphocytes, neutrophils
Describe the mechanism of airflow obstruction in emphysema/COPD
loss of elasticity and alveolar attachments due to emphysema, results in airways collapse on expiration, causes airtrapping and hyperinflation. Goblet metaplasia with mucus plugging of lumen, inflammation of the airway wall, thickening of bronchiolar wall- smooth muscle hypertrophy and peribronchial fibrosis
Does haemoptysis feature in COPD?
rarely
Name two features of COPD that would suggest steroid responsiveness
- previous diagnosis of asthma or atopy
- a higher blood eosinophil count
- substantial variation in FEV1 over time (at least 400 ml)
- substantial diurnal variation in peak expiratory flow (at least 20%)
