COPD Flashcards
What does COPD stand for?
Chronic obstructive pulmonary disease
What is the definition of COPD? (3 points)
- Non-reversible
- Long term deterioration in air flow thru lungs
- Caused by damage to lung tissue
What are the CF of COPD? (13 things)
- Fatigue / lethargy
- Coryza
- Worsening SOB
- Pursed lip breathing
- Prod cough
- Wheeze
- Haemoptysis
- Chest pain / tightness
- Tachycardia
- Tachypnoea
- Hypoxia
- Peripheral oedema
- Cyanosis
What recurrent thing will COPD pt complain of?
Recurrent chest infections
What are some DDx that present similarly to COPD? (5 things)
- Asthma
- Bronchiectasis
- CHF
- Lung cancer
- TB
How can you differentiate Asthma from COPD? (4 things)
Asthma has:
1. Diurnal variation in symptoms + Peak flow
1. Atopy Hx
1. Eosinophilia (blood + sputum)
1. Bronchodilator reversibility (do Lung function tests to c)
How can you differentiate Bronchiectasis from COPD? (3 things)
Bronchiectasis has:
1. More sputum
1. More frequent LRTIs (starts in childhood)
1. Bronchial dilation (do CT to c)
How can you differentiate CHF from COPD? (6 things)
CHF has:
1. Orthopnoea (SOB lying down)
1. PND
1. CVS Hx
1. Fine basal inspiratory crepitations
1. Elevated BNP
1. Reduced EF (do echo to c)
How can you differentiate Lung cancer from COPD? (3 things)
Lung cancer has:
1. WL
1. Haemoptysis (proper)
1. Tumour presence (do CXR / bronchoscopy to c)
How can you differentiate TB from COPD? (3 things)
TB has:
1. WL
1. Night sweats
1. Positive sputum culture / microscopy
What scoring system does NICE recommend to assess SOB of COPD pt?
MRC Dyspnoea Scale
What are the grades in the MRC Dyspnoea Scale? (5 things)
- Grade 1: SOB @ strenuous exercise
- Grade 2: SOB @ walking up hill
- Grade 3: SOB that slows down ur walking on flat
- Grade 4: Stop to catch breath after walking 100m on flat
- Grade 5: Can’t leave house bc SOB
What is the Dx of COPD based on? (2 things)
- Clinical
- Spirometry
What will Spirometry show in COPD?
- Obstructive picture aka FEV1 / FVC ratio: less than 0.7
- (overall lung capacity not as bad as ability to quickly blow air out lungs)
- If Spirometry results dramatically improve when you give Salbutamol what should you consider?
- Asthma as alternate Dx
What other investigations can you do to help Dx / exclude DDx? (7 things)
- CXR (cancer)
- FBC (anaemia / polycthaemia)
- BMI (WL)
- Sputum culture (TB / pseudomonas)
- ECG / Echo (CVS)
- CT (fibrosis / cancer / bronchiectasis)
- Serum alpha 1 antitrypsin (alpha 1 antitrypsin def)
What are exacerbations of COPD usually due to?
Infections
(so they’re called Infective exacerbations)
What investigation should you do in COPD exacerbation?
ABG
What will the ABG show in ACUTE exacerbation of COPD?
Resp acidosis
What does the ABG show in Resp acidosis aka ACUTE exacerbation of COPD? (2 things)
- Low pH
- Raised pCO2
What does the results of Resp acidosis mean?
Pt not able to get rid of CO2 acutely, so blood becomes acidotic
(Low pH + Raised pCO2)
What does a raised Bicarbonate indicate in ABG of COPD? (2 things)
- Pt chronically retains (can’t get rid of) CO2
- Kidneys have responded by prod HCO3 to balance acidity
What happens to Bicarbonate levels in ABG of acute exacerbation of COPD? (2 steps)
- Kidney HCO3 production can’t keep up with rising level of CO2
- So pt –> acidotic, despite having higher HCO3 than avg person
What result in an ABG indicates Resp FAILURE?
Low pO2 (aka hypoxia)
What are the ABG results of Type 1 Rep Failure? (2 things)
- Normal pCO2
- Low pO2
(only ONE is affected lol)
What are the ABG results of Type 2 Rep Failure? (2 things)
- Raised pCO2
- Low pO2
(TWO are affected)
What other investigations should you do for COPD exacerbation? (6 things)
- CXR (pneumonia)
- ECG (arrhythmia / HF)
- FBC (inf)
- UnE (electrolytes affected by inf / meds)
- Sputum culture (inf)
- Blood cultures (if septic)
What is the general rule for Oxygen therapy of COPD pt who DOESN’T retain CO2 + Bicarbs normal (aka can get rid of CO2 normally)?
Give O2 + Aim for Oxygen sats 94+
What is the general rule for Oxygen therapy of COPD pt who RETAINS CO2 (aka CAN’T get rid of it normally)?
Venturi Mask + Aim for sats 88-92%
What are the Mx options of COPD exacerbation if well enough to stay HOME? (3 things)
- Prednisolone 30mg OD for 7-14 days
- Inhalers / home nebulisers
- Abx (if inf)
What are the Mx options for COPD exacerbation if HOSPITALISED? (4 things)
- Nebulised bronchodilators (Salbutamol / ipratropium)
- Steroids (hydrocortisone / prednisolone)
- Abx (if inf)
- Phsyio (to clear sputum)
What are the Mx options for SEVERE exacerbations of COPD not responding to Tx? (4 things)
- IV Aminophylline
- Non-invasive ventilation (NIV)
- Intubation / ventilation –> ITU
- Doxapram (resp stimulant used when NIV / intubation not appropriate)
What are the basic LONG TERM Mx options for COPD? (2 things)
- X Smoking
- Pneumococcal + Flu vax
What is Step 1 in LONG TERM Mx of COPD? (2 things)
SABA (Salbutamol / Terbutaline) OR
SAMA (Ipratropium bromide)
(one or the other)
What is Step 1 in LONG TERM Mx of COPD? (2 things)
SABA (Salbutamol / Terbutaline) OR
SAMA (Ipratropium bromide)
(one or the other)
What is Step 2 in LONG TERM Mx of COPD if they DO NOT have Asthmatic / Steroid responsive CF? (2 things)
- LABA
- LAMA
(can have them in 1 combo inhaler)
What is Step 2 in LONG TERM Mx of COPD if they DO HAVE Asthmatic / Steroid responsive CF? (2 things)
- LABA
- ICS
(can have them in 1 combo inhaler)
What is Step 3 in LONG TERM Mx of COPD if they DO HAVE Asthmatic / Steroid responsive CF? (3 things)
- LABA
- ICS
- LAMA
What problems warrant a COPD pt going on Long Term Oxygen Therapy (LTOT)? (4 things)
Less than 7.3 pO2
OR
7.3 - 8 with one of following
1. Polycthaemia
2. Peripheral Oedema
3. Pulm HTN
What is a CI for LTOT in COPD pt? Why?
- Smoking
- Bc cigs + oxygen = fire hazard
