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Yr3 - Resp Conditions > COPD > Flashcards

COPD Flashcards

1
Q

What is the management of steroid-responsiveness COPD?

A

LABA + ICS

escalate to triple therapy of LABA + ICS + LAMA if still not managed

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2
Q

What is the most common caustive organism in infective exacerbations of COPD?

A

Haemophilus influenza

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3
Q

What is COPD?

A

A chronic progressive lung disorder that is characterised by irreversible airflow obstruction, encompassing both chronic bronchitis and emphysema.

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4
Q

What genetic deficiency is associated with COPD?

A

Alpha-1-antitrypsin deficiency

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5
Q

What is main cause of COPD?

A

Bronchial and alveolar damage because of environmental toxins (cigarette smoke).

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6
Q

What is the presentation of COPD?

A
  • Chronic cough with sputum production
  • breathlessness (Especially exertional)
  • Wheeze
  • Decreased exercise tolerance
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7
Q

What are the examination findings for COPD?

A

reduced chest expansion
use of accessory muscles
cyanosis

Barrel-shaped overinflated chest

Percussion: Hyperresonant chest

Auscultation: Quiet breath sounds, prolonged expiration wheeze, rhonchi (bubbling sound in inspiration + expiration) and crepitations

Signs of CO2 retention: Bounding pulse, warm peripheries, flapping tremor

possible signs of cor pulmonale/RHF –> peripheral edema + hepatomegaly

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8
Q

What investigations are performed in diagnosing COPD?

A

spirometry - FEV1/FVC ratio
CXR
ABG

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9
Q

What does spirometry reveal in COPD?

A

Decreased FEV1: FVC ratio of <70%

FEV1 is used to characterise severity

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10
Q

What is the characteristic feature for COPD when compared with asthma in terms of bronchodilator?

A

No bronchodilator reversibility

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11
Q

What is seen on a CXR for a patient with COPD?

A
  • Reveals hyperinflation (>6 anterior ribs, flat hemidiaphragm).
  • Decreased peripheral lung markings
  • Elongated cardiac silhouette - due to emphysema
  • Bullae
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12
Q

What type of respiratory failure is associated with COPD?

A

Type 2 respiratory failure (low O2 + high CO2)

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13
Q

What is the lifestyle management for COPD?

A

Smoking cessation
annual flu vaccine
one off pneumococal vacinne
pulmonary rehab if they class themselves as being functionally disabled by COPD

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14
Q

what would you expect to find on suspected COPD patients bloods

A

seondary polycythaemia - high numbers of RBC

chronic hypoxia –> increased erythropoeitin production –> increased RBC production

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15
Q

What is the first-line management for COPD?

A

SABA or SAMA

Salbutamol or ipratropium bromide

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16
Q

If there are more than 2 COPD exacerbations per year what is the step-up management for COPD?

A

LAMA + LABA

or if they have features of asthmatic response then LABA + ICS

17
Q

Describe asthmatic features/steroid responsiveness in COPD

A

Previous diagnosis of asthma/atopy
Raised blood eosinophil count
Substantial variation in FEV1 over time (at least 400ml)
Substantial diurnal variation in peak expiratory flow (at least 20%)

18
Q

What is COPD?

A

Irreversible airway obstruction
Emphysema + chronic bronchitis

bronchitis - hypertrophy and hyperplasia of the mucus glands in the bronchi
emphysema - enlargement of air spaces and destruction of alveolar walls (loss of elastic recoil)

19
Q

What is the biggest risk factor for COPD?

A

Smoking

20
Q

What is the presentation of COPD?

A

Dyspnoea (persistent) –> use MRC dyspnoea scale to assess

  • Exercise induced
  • Progressive

Chronic productive cough for at least 3 months in at least 2 consecutive years without other identifiable cause
Concurrent wheeze
Increased respiratory effort - Flared nostrils, accessory muscles

Hypercapnia - Co2 retention flap and bounding pulse

Tachypnoea

Barrel chest

Cor pulmonale - RV heave, JVP elevated and ankle oedema

Hoover’s sign - inspiratory retraction of the lower intercostal spaces that occurs with obstructive airway disease

21
Q

What is the gold-standard investigations for COPD?

A

Spirometry - post-bronchodilator FEV1/FVC <0.7 with no bronchodilator reversibility

Low oxygen saturations

CXR - hyper-expansion, bullae (trapped air pockets)

Exclude anaemia + lung cancer as causes of breathlessness

22
Q

What test assesses COPD impact on quality of life?

A

CAT

COPD assessment test

23
Q

What is the first step of COPD management?

A

Smoking management

-Offer pneumococcal and influenza vaccines

24
Q

What is the long-term management for COPD is there are asthmatic features?

A

LABA + ICS

25
Q

What are asthmatic features in COPD?

A

FEV1 variability, high eosinophils, peak flow variability

26
Q

what are the features of asthma COPD overlap

A

over 40yrs with persistent airflow obstruction (i.e. wheeze, cough, dyspnoea)
history of cigarette smoking or exposure to biomass fuel
history of asthma or strong bronchodilator reversibility on spirometry

27
Q

What parameter is used to assess for COPD severity?

A

FEV1

28
Q

What is the long term management for asthma-COPD overlap?

A

SABA or SAMA as required
escalate to LABA/LAMA + ICS

lifestyle management - stop smoking, vaccines etc

29
Q

What is the management for acute exacerbations of COPD?

A

O2 sats should be 88-92%
give O2 via blue venturi mask

increase frequency of bronchodilator use and consider giving via a nebuliser if they get fatigued

give prednisolone 30 mg daily for 5 days

oral antibiotics if sputum colour changes or increases in volume of thickness more than normal
1st line –> amoxicillin 500mg x3 for 5 days
(or clarithromycin or doxycycline.=)

30
Q

what are the indications for long term oxygen therapy in COPD

A

have to be non smoking (due to burns risk)

AND

paO2 < 7.3kPa

OR

paO2 7.3-8kPa and 1 or more:
secondary polycythaemia, peripheral oedema, pulmonary HTN

31
Q

what are the main differentiating features between asthma + COPD

A
32
Q

what are the signs of an acute exacerbation of COPD

A

Worsening breathlessness.
Increased sputum volume and purulence (change from colourless to yellow/green).
Cough
Wheeze
Fever without an obvious source
Upper respiratory tract infection in the past 5 days.
Increased respiratory rate or heart rate

severe:
can’t carry out activities of daily living
new onset peripheral cyanosis

33
Q

what are the features of asthma COPD overlap

A

over 40yrs with persistent airflow obstruction (i.e. wheeze, cough, dyspnoea)
history of cigarette smoking or exposure to biomass fuel
history of asthma or strong bronchodilator reversibility on spirometry

34
Q

summarise obstructive vs restrictive spirometry findings

A

Yr3 - Resp Conditions (6 decks)

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