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A- Resp and cardio > COPD > Flashcards

COPD Flashcards

1
Q

What are the signs of a COPD exacerbation

A

-sputum
-viscous
-colour change

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2
Q

What can cause young onset COPD/emphysema

A

Alpha 1 antitrypsin deficiency -> damage to lung tissue with infection

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3
Q

What is the function of alpha 1 antitrypsin

A

Neutralise enzymes in lungs to protect the tissue

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4
Q

What comes under COPD

A

Emphysema and chronic bronchitis

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5
Q

COPD presentation

A
  • Chronic cough
  • Recurrent chest infections
  • SOB on exertion and wheeze
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6
Q

What are pink puffers?

A

Pink puffer = no hypoxic drive, pink and well perfused but hard to blow off CO2 - thin and puffing - SOB

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7
Q

What are blue bloaters?

A
  • Rely on hypoxic drive
  • Retain C02 and maintain low sats
  • Won’t be SOB
  • BARREL CHEST
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8
Q

What is bullae?

A

Areas of trapped air in advanced COPD - prone to rupture and cause pneumothorax

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9
Q

Bloods investiagtions and why COPD

A
  • 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
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10
Q

Investigations beyond for COPD

A
  • 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
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11
Q

Management of chronic COPD except meds

A
  • Smoking cessation
  • Pneumococcal and flu vaccines
  • Pulmonary rehab
  • Optimise comorbidities
    -Longterm home O2 use
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12
Q

Chronic management of COPD medications if

A

SABA or SAMA
No imporvement: asthmatic -> LABA + ICS, non = + LAMA
No improvement -> + LAMA or ICS

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13
Q

What is chronic bronchitis?

A

Productive cough for at least 3 months in each year for 2 consecutive years

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14
Q

What is emphysema?

A

Enlargement of the air spaces distal to the terminal bronchioles in the lungs from dilatation, destruction or distension of their walls

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15
Q

Risk factos for COPD

A

Smoking
Occupational exposure
Air pollution
Genetics - alpha 1 antitrypsin deficiency

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16
Q

What oxygen flow do you start with for acute COPD?

A

24-28% venturi mask. increase to get to 88-92% O2 sats

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17
Q

Medications use in acute COPD

A

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

18
Q

What offer if no response to nebulised bronchodilators?

A

IV salbutamol or aminophylline

19
Q

When to use non invasive positive pressure ventilation in acute COPD?

A

No response above and if respiratory rate >30 OR pH <7.35, guided by ABG

20
Q

When is oral theophylline indicated in chronic COPD?

A

Trials of SABAs and LABAs or can’t use inhaled therapy

21
Q

When is long term O2 offered to chronic COPD patients?

A

PO2 < 7.3 kPa
PO2 7.3-8kPa and one of
Secondary polycythaemia
Nocturnal hypoxia
Peripheral oedema
Pulmonary hypertension

22
Q

What results suggest polycythaemia?

A

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).

23
Q

What is polycythaemia?

A

Raised concentration of RBC in the blood

24
Q

Why is polycythaemia important?

A

Increases risk of thromboembolic complications

25
Q

Absolute vs apparent polycythaemia

A

absolute – both haematocrit (Hct) level and red cell mass are elevated
apparent – people with raised venous haematocrit (Hct) but with a red cell mass within reference range

26
Q

What medications can be used in chronic productive cough COPD?

A

Mucolytics eg Carbocisteine and acetylcysteine
Prophylactic antibiotics eg azithromycin

27
Q

Pathophysiology of chronic bronchitis causing Bronchical wall narrowing

A

Increased number of goblet cells and size of bronchial submucosal glands redulting in mucous hypersecretion
Compounded by squamous metaplasia of epithelium causing ciliary dysfunction
Causes airflow limitations mainly in small airways caused by inflammation, narrowing and inflammatory exudates

28
Q

Pathophysiology of emphysema

A

Alveolar walls destroyed -> bullae formationa nd fusion of adjacent alveoli
Causes reduced exchange, decreased elastic recoil, progressive air trapping and hyperinflation

29
Q

Signs of COPD

A

Tachypnoea
Breathlessness on exertion
Increased use of accessory muscle of respiration
Pursed lip breathing
Cyanosis
Wheeze
Hyperinflation - barrel chest
Abnormal posture
Drowsiness, flapping tremor, mental confusion - increase CO2
Signs of cor pulmonale, peripheral oedema, raised JVP

30
Q

Complications of COPD

A

Acute exacebations +/- infections
Polycythaemia
Respiratory failure type 2
Cor pulmonale - RHF secondary to chronic pulmonary HPTN
Pneumothorax
Lung cancer

31
Q

How to grade severity of COPD

A

Mecial Research council dyspnoea scale grade 1 -5
Via spirometry

32
Q

What is a severe/ very severe stage of COPD on spirometry?

A

Severe = 30-49% FEV1
Very severe = FEV1 < 30% predicted value

33
Q

Mild vs moderate value for COPD severity on spirometry

A

FEV1 > 80% = mild
FEV1 50-79% = moderate

34
Q

If someone is SOB on medium levels of exertion eg hurried walking what MRC dyspnoea grade are they?

A

Grade II

35
Q

Which MRC grade starts to affect ability to walk because of dyspnoea?

A

Grade III

36
Q

Whats the difference between Grade 4 and 5 MRC for COPD severity?

A

Grade 4 - can’t walk more than 100m or stop after a few mins walking on ground level
Grade 5 - too breathless to leave the house/ undressing

37
Q

How to determine if there are asthmatic features to the COPD?

A

Prev secure diagnosis of asthma or atopy
Higher blood eosinophil count
Substantial variation on FEV1 overtime at least 400ml
Substantial diurnal variation in peak expiratory flow (at least 20%)

38
Q

Stepwise inhaler therapy for COPD

A

SABA or SA,A
Remain breathless ->
IF asthma or steroid responsive features
-LABA + ICS
If none -> LABA + LAMA ( if on SAMA swithc to SABA)
If remain breathless offer triple therapy - LAMA + LABA + ICS

39
Q

What drugs cause pulmonary fibrosis?

A

Methotrexate
Amiodarone
Nitrofurantoin

40
Q

What do PDE4 inhibitors do in COPD

A

Eg rofumilast
Reduce the risk of exacerbations in COPD

41
Q

When prescribe PDE4inhibitor in COPD

A

Severe disease FEV1 <50%
2 or more exacerbations last 12 months despite triple therapy

42
Q

Cor pulmonae treatment

A

Loop diuretic
Long term 02

NOT ace I or beta blockers

A- Resp and cardio (58 decks)

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