COPD Flashcards
What are the signs of a COPD exacerbation
-sputum
-viscous
-colour change
What can cause young onset COPD/emphysema
Alpha 1 antitrypsin deficiency -> damage to lung tissue with infection
What is the function of alpha 1 antitrypsin
Neutralise enzymes in lungs to protect the tissue
What comes under COPD
Emphysema and chronic bronchitis
COPD presentation
- Chronic cough
- Recurrent chest infections
- SOB on exertion and wheeze
What are pink puffers?
Pink puffer = no hypoxic drive, pink and well perfused but hard to blow off CO2 - thin and puffing - SOB
What are blue bloaters?
- Rely on hypoxic drive
- Retain C02 and maintain low sats
- Won’t be SOB
- BARREL CHEST
What is bullae?
Areas of trapped air in advanced COPD - prone to rupture and cause pneumothorax
Bloods investiagtions and why COPD
- identify a naemia or polycythemia
-Eosinophils raised if asthmatic component- Baseline bloods for new chronic diagnosis
- U+E, CRP, LFT
-Culture and sensitivity - infection sus
Investigations beyond for COPD
- Spirometry
+/-
- Sputum culture - infection sus
- ECG - HD or cor pulmonale
ECHO - assess cardiac features - Serum alpha antitrypsin if <35 yrs young onset symptoms, FH or lack smoking hisotry
- CT thorax - anything concerning on Xray, sympotms dont match, imaging of emphysematous bullae
-Spirometry - FEV1/FVC under 70%. findings or suspect another diagnosis eg pulmonary fibrosis
Management of chronic COPD except meds
- Smoking cessation
- Pneumococcal and flu vaccines
- Pulmonary rehab
- Optimise comorbidities
-Longterm home O2 use
Chronic management of COPD medications if
SABA or SAMA
No imporvement: asthmatic -> LABA + ICS, non = + LAMA
No improvement -> + LAMA or ICS
What is chronic bronchitis?
Productive cough for at least 3 months in each year for 2 consecutive years
What is emphysema?
Enlargement of the air spaces distal to the terminal bronchioles in the lungs from dilatation, destruction or distension of their walls
Risk factos for COPD
Smoking
Occupational exposure
Air pollution
Genetics - alpha 1 antitrypsin deficiency
What oxygen flow do you start with for acute COPD?
24-28% venturi mask. increase to get to 88-92% O2 sats
Medications use in acute COPD
Nebulised bronchodilators - salbutamol 5mg, ipatropium bromide 500ug
Steroids - oral prednisolone 40mg, IV hydrocortisone 200mg
Antibiotics
Non invasive positive pressure ventilation - NIPPV
ITU or intubation if inadequate response to above
What offer if no response to nebulised bronchodilators?
IV salbutamol or aminophylline
When to use non invasive positive pressure ventilation in acute COPD?
No response above and if respiratory rate >30 OR pH <7.35, guided by ABG
When is oral theophylline indicated in chronic COPD?
Trials of SABAs and LABAs or can’t use inhaled therapy
When is long term O2 offered to chronic COPD patients?
PO2 < 7.3 kPa
PO2 7.3-8kPa and one of
Secondary polycythaemia
Nocturnal hypoxia
Peripheral oedema
Pulmonary hypertension
What results suggest polycythaemia?
raised venous haematocrit (Hct) (>0.52 males, >0.48 females for > 2 months) or haemoglobin (in men greater than 18.0 g per L or in women with values greater than 17.0 g per L) (1).
What is polycythaemia?
Raised concentration of RBC in the blood
Why is polycythaemia important?
Increases risk of thromboembolic complications
