COPD Flashcards
What is the management of steroid-responsiveness COPD?
LABA + ICS
escalate to triple therapy of LABA + ICS + LAMA if still not managed
What is the most common caustive organism in infective exacerbations of COPD?
Haemophilus influenza
What is COPD?
A chronic progressive lung disorder that is characterised by irreversible airflow obstruction, encompassing both chronic bronchitis and emphysema.
What genetic deficiency is associated with COPD?
Alpha-1-antitrypsin deficiency
What is main cause of COPD?
Bronchial and alveolar damage because of environmental toxins (cigarette smoke).
What is the presentation of COPD?
- Chronic cough with sputum production
- breathlessness (Especially exertional)
- Wheeze
- Decreased exercise tolerance
What are the examination findings for COPD?
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
What investigations are performed in diagnosing COPD?
spirometry - FEV1/FVC ratio
CXR
ABG
What does spirometry reveal in COPD?
Decreased FEV1: FVC ratio of <70%
FEV1 is used to characterise severity
What is the characteristic feature for COPD when compared with asthma in terms of bronchodilator?
No bronchodilator reversibility
What is seen on a CXR for a patient with COPD?
- Reveals hyperinflation (>6 anterior ribs, flat hemidiaphragm).
- Decreased peripheral lung markings
- Elongated cardiac silhouette - due to emphysema
- Bullae
What type of respiratory failure is associated with COPD?
Type 2 respiratory failure (low O2 + high CO2)
What is the lifestyle management for COPD?
Smoking cessation
annual flu vaccine
one off pneumococal vacinne
pulmonary rehab if they class themselves as being functionally disabled by COPD
what would you expect to find on suspected COPD patients bloods
seondary polycythaemia - high numbers of RBC
chronic hypoxia –> increased erythropoeitin production –> increased RBC production
What is the first-line management for COPD?
SABA or SAMA
Salbutamol or ipratropium bromide
If there are more than 2 COPD exacerbations per year what is the step-up management for COPD?
LAMA + LABA
or if they have features of asthmatic response then LABA + ICS
Describe asthmatic features/steroid responsiveness in COPD
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%)
What is COPD?
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)
What is the biggest risk factor for COPD?
Smoking
What is the presentation of COPD?
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
What is the gold-standard investigations for COPD?
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
What test assesses COPD impact on quality of life?
CAT
COPD assessment test
What is the first step of COPD management?
Smoking management
-Offer pneumococcal and influenza vaccines
What is the long-term management for COPD is there are asthmatic features?
LABA + ICS
What are asthmatic features in COPD?
FEV1 variability, high eosinophils, peak flow variability
what are the features of asthma COPD overlap
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
What parameter is used to assess for COPD severity?
FEV1
What is the long term management for asthma-COPD overlap?
SABA or SAMA as required
escalate to LABA/LAMA + ICS
lifestyle management - stop smoking, vaccines etc
What is the management for acute exacerbations of COPD?
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.=)
what are the indications for long term oxygen therapy in COPD
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
what are the main differentiating features between asthma + COPD
what are the signs of an acute exacerbation of COPD
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
what are the features of asthma COPD overlap
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
summarise obstructive vs restrictive spirometry findings
