COPD Flashcards
What is COPD?
Progressive and irreversible condition of the lung characterized by chronic
obstruction to air flow.
- destruction of small airways( bronchioles) which lead to losing the function of lung ( ventilation)
What is the main risk factor of copd?
Smoking smoking smoking
What is the genetic cause of copd?
a1-antitrypsin deficiency ( its main function is the inhbit the function of
How do we diagnose chronic bronchitis?
By clinical diagnosis which are It comes with
chronic cough , productive of sputum for at least
3 months per year for at least 2 consecutive years.
What are the types of copd?
1-Chronic bronchitis.
2- emphysema
How does emphysema occur?
Emphysema : It is s a pathologic diagnosis of permanent enlargement of air spaces distal
to terminal bronchioles due to destruction of alveolar walls.
1-Which maybe due risk factor of genetics.
2- progression of chronic
bronchitis.
Classified by the pattern of the enlarged airspaces:
o Centriacinar
o Panacinar
o Paraseptal
What are the risk factors of copd?
1- The most important is smoking.
2- Air pollution
3- occupational exposure like dust.
4. low-birth-weight( may reduce maximally attained lung function.
5- infections
6- low socio-economic status
Also genetics which are alpha1-antitrypsin deficiency.
What happen in chronic copd?
weight loss and skeletal muscle
dysfunction
Commonly associated comorbid conditions include cardiovascular
disease, cerebrovascular disease, the metabolic syndrome
osteoporosis, depression and lung cancer.
What is hyperinflation?
Occurring when air gets trapped in the lungs and causes them to overinflate.
it occurs by blockage in the air passages or by air sacs that are less elastic which interferes with the explosion of air from the lungs
What are the signs of chronic bronchitis ?
1- chronic bronchitis
A) cyanosis
B) peripheral edema from RHF ( cor pulomnale)
C) crackles and wheezing.
D) prolonged expiration
E) frequntly obese.
What are the signs of emphysema?
1-Pink skin.
2- accessory muscle use .
3-hyperinflation( barrel chest )
4-hyperresonance in percussion
Cachectic appearance ( lose weight and muscle mass) due to calorie consumption form increased of breathing.
5- decreased breath sound.
Why do we hear muffled heart sound?
Due to hyperinflation
What is the gold investigation in COPD ?
High-resolution computed tomography HRRCT
What is the purpose of PFT in copd?
Decreased FEV1 and decreased FEV1/FVC ratio GOLD staging is based on FEV1.
o ≥80% of predicted value is mild disease
o 50% to 80% is moderate disease
o 30% to 50% is severe disease
o <30% is very severe disease.( mortality is 80%)
Inversible airway obstruction after bronchodilators
What is the purpose of chest x ray in COPD?
Low sensitivity for diagnosing COPD
only severe, advanced emphysema will show the typical changes, which
include:
o Hyperinflation
o Flattened diaphragm
o Enlarged retrosternal space
o Diminished vascular markings
Useful in an acute exacerbation to rule out complications
o Pneumonia
o Pneumothorax
o Pneumomediastinum
o Foreign body
What is the treatment that improves the mortality in copd?
Is oxygen therapy
Why do we need to keep the oxygen level between 88 and 92?
Too much in oxygen will worse the co retention.
What is the management of copd?
1- smoking cessation: the most important intervention, prolongs the survival rate but does not reduce it to the level of someone who has never smoked.
2- Bronchodilators :
o Short-acting bronchodilators may be used for patients with mild disease
o longer-acting bronchodilators are usually more appropriate for those with moderate to severe disease.
3-Combined inhaled glucocorticoids( less than 5- 7 days) and bronchodilators :
o Improves lung function
o Reduces the frequency and severity of exacerbations
o Improves quality of life.
4- Oral glucocorticoids :useful during exacerbations
5- Pulmonary rehabilitation .
6****- Oxygen therapy, Long-term oxygen therapy (LTOT) :
o Improves survival in selected patients with COPD complicated by severe hypoxaemia (arterial PaO 2< 7.3 kPa (55 mmHg)
o Minimum 16 hrs /day.
7- Surgical intervention :lung volume reduction surgery (LVRS) or Bullectomy
Vaccination : annual influenza vaccination and pneumococcal vaccination.
Antibiotics
Non-invasive ventilation
We don’t give inhaler corticosteroid to copd patients unless it’s acute or on late stage with triple therapy
What is differential diagnosis of copd?
Exacerbation Pneumothorax CHF exacerbation Acute MI Pneumonia and other infectious PE
Tratment of acute severe copd?
1-Keep saturation 88-92 % and above to prevent more accumulation of CO2 and worsening VQ mismatch •
2-Noninvasive positive pressure ventilation (NPPV) (bilevel positive airway pres- sure [BIPAP] or CPAP).
3- If life-threatening, intubate in ED and refer to ICU admission for ventilation (chance of ventilation dependency)
4-Inhaled β2-agonist (first-line therapy).
• Via nebulizer or MDI
• Assess patient response to bronchodilators (clinically and with peak flows).
5- Corticosteroids
• Traditionally given intravenously initially, but may also be given orally if given in equivalent doses.
• Taper IV or oral corticosteroids, but only when clinical improvement is seen.
• Initiate inhaled corticosteroids at the beginning of the tapering schedule. • Antibiotics • When
the patient stable : Guidelines for treatment are based on severity.
What is the indication on intubation?
If a trauma patient the GCS less than 13- 12
But nontrauma patient is between 9-8
Copd prognosis?
Prognostic factors:
o frequency and severity of acute exacerbations is the single best predictor
o lung function tests and scores of dyspnea severity
o development of hypoxemia, hypercapnia or cor pulmonale
5yrsurvival
o FEV1 <1L=50%
o FEV1 <0.75 L = 33%
BODE index for risk of death in COPD
