COPD Flashcards
what is the definition of COPD?
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease state characterised by airflow limitation that is not fully reversible. It encompasses both emphysema and chronic bronchitis. The airflow limitation is usually progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases.
what is the epidemiology of COPD?
More common in older people
Deaths increasing
Mortality higher in men
Smoking
what is the aetiology of COPD?
Tobacco smoking is by far the main risk factor for COPD. It is responsible for 40% to 70% of COPD cases and exerts its effect by causing an inflammatory response, cilia dysfunction, and oxidative injury. Air pollution, indoor burning of biomass fuels, and occupational exposure to dusts, chemical agents, and fumes are other aetiologies.
what are the risk factors for COPD?
Smoking
Advance aged
Genetic
Lung growth and development
what is the pathophysiology of COPD?
The hallmark of COPD is chronic inflammation that affects central and peripheral airways, lung parenchyma and alveoli, and pulmonary vasculature. Repeated injury and repair leads to structural and physiological changes. The inflammatory and structural changes in the lung increase with disease severity and persist after smoking cessation.
The main components of these changes are narrowing and remodelling of airways, increased number of goblet cells, enlargement of mucus-secreting glands of the central airways, alveolar loss, and, finally, vascular bed changes leading to pulmonary hypertension.
what are the key presentations of COPD?
Cough
Shortness of breath
Sputum production
Exposure to risk factors
what are the first line and gold standard investigations for COPD?
Spirometry - FEV1/FVC ratio <0.70; total absence of reversibility is neither required nor the most typical result
Standardised symptoms score - mMRC score ranges from 0-4; CAT score ranges from 0-40: mMRC ≥2 or CAT score ≥10 indicates higher symptoms burden
Pulse oximetry - low oxygen saturation
ABG - PaCO₂ >50 mmHg and/or PaO₂ of <60 mmHg suggests respiratory insufficiency
CXR - hyperinflation, flattened diaphragm
FBC - raised haematocrit, anaemia, possible increased WBC count
ECG - signs of right ventricular hypertrophy, arrhythmia, ischaemia
what are the differential diagnoses for COPD?
Asthma
Congestive heart failure
Bronchiectasis
Tuberculosis
how is COPD managed?
Group A:
Short or long acting bronchodilator (salbutamol inhaled: (100 micrograms/dose inhaler) 100-200 micrograms (1-2 puffs) every 4-6 hours when required)
Group B:
LABA or LAMA (salmeterol inhaled: (50 micrograms/dose inhaler) 50 micrograms (1 puff) twice daily OR tiotropium inhaled: (18 micrograms/capsule inhaler) 18 micrograms (1 capsule) once daily; (2.5 micrograms/dose inhaler) 5 micrograms (2 sprays) once daily), plus short acting bronchodilator, pulmonary rehabilitation
Group C:
LAMA, bronchodilator, pulmonary rehabilitation
Group D:
LABA or LAMA or ICS, short acting bronchodilator, pulmonary rehabilitation
how is COPD monitored?
Patients with COPD should be evaluated on a regular basis depending on the severity of disease. Mild stable COPD patients may be followed up at 6-month intervals, while patients with severe frequent exacerbations, and recently hospitalised patients, need follow-up at 2-week to 1-month intervals.
what are the complications of COPD?
Cor pulmonale
Lung cancer
Recurrent pneumonia
what is the prognosis of COPD?
COPD is a disease with an indeterminate course and variable prognosis. Its prognosis depends on several factors including genetic predisposition, environmental exposures, comorbidities, and, to a lesser degree, acute exacerbations.
which organism is most likely to cause pneumonia in a COPD patient?
haemophilus influenza
What type of blood gas abnormality does COPD most commonly cause?
respiratory acidosis
what is chronic bronchitis?
chronic productive cough for at least 3 months in at least 2 years
