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Respiratory > COPD > Flashcards

COPD Flashcards

1
Q

What two clinical features characterise COPD?

A
  • chronic bronchitis
  • emphysema
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2
Q

What are the RFs for COPD?

A
  • smoking
  • occupational exposure (dust, silica)
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3
Q

Define chronic bronchitis

A

Productive cough >3m (2+ years)

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4
Q

What is the pathophysiology of emphysema?

A

Inflammatory response to tobacco smoke tips balance of enzymes towards elastases.
- destruction of alveolar wall = loss of elastic recoil (airways collapse on exhalation)
- trapped air in alveoli = hyperinflation
- impaired gas exchange (hypoxaemia & CO2 retention)

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5
Q

What is a-1 antitrypsin deficiency?

A

AD disorder - a1-antitrypsin insufficient to inhibit neutrophil elastase as sequestered in the liver
= accumulation of elastase in lungs & damage to lung parenchyma
- COPD early onset (<45) esp in smokers
- liver cirrhosis

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6
Q

What are the classic symptoms of COPD?

A
  • SOBOE
  • chronic productive cough (smoking hx)
  • wheeze / chest tightness
  • RTI exacerbation
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7
Q

What clinical findings indicate COPD on examination?

A
  • target sats 88-92%
  • pursed lip breathing & tripoding
  • WL (accessory muscle use)
  • barrel chest, hyper resonance, expiratory wheeze
  • cyanosis (chronic hypoxaemia)
  • cor pulmonale signs
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8
Q

What are the clinical signs of cor pulmonale?

A

PHTN -> RHF
- COPD etc
- raised JVP
- peripheral oedema
- hepatomegaly

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9
Q

How is COPD diagnosed?

A

PFTs (spirometry)
- FVC/FEV1 ratio
- non-reversible after bronchodilator (<12% increase in FEV1)
- air trapping = increased TLC & RV

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10
Q

What is FVC?

A

Forced vital capacity
= Max air expired after max inspiration

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11
Q

What is FEV1?

A

Forced expiratory volume (1s)
= max expiration in 1s

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12
Q

What are the target sats for COPD & CO2 retainers?

A

88-92%

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13
Q

Which is reduced more in COPD: FVC or FEV1?

A

FEV1

FEV1/FVC ratio = <70% of expected (for age, gender, height, weight)

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14
Q

When is it appropriate to screen for a-1 antitrypsin deficiency?

A
  • <45
  • no RFs for COPD
  • FHx COPD
  • unexplained liver disease
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15
Q

What organisation dictates the pathways for COPD management?

A

BTS - British Thoracic Society

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16
Q

What conservative therapies exist for COPD management?

A
  • smoking cessation clinics/apps
  • vaccinations (annual flu & pneumococcal)
  • pulmonary rehab
  • education programmes
  • long-term O2Tx
  • treat comorbidities
17
Q

When is domiciliary oxygen appropriate for COPD patients?

A

ABG:
- sats <88%
- PaO2 <55mmHg

+RHF or raised Hct:
- sats <90%
- PaO2 <60mmHg

18
Q

Why are the target sats for COPD lower?

A

Hypoxaemia needed to stimulate respiratory drive to breathe out excess CO2

Necessary to preserve shunting:
- vasoconstriction in hypoxia to shunt blood to better ventilated regions

19
Q

What is a crucial modifiable risk factor for poor COPD management to screen for when producing a care plan?

A

Ability to use an inhaler
- coordination
- understanding
- technique

20
Q

What symptoms are indicative of a COPD exacerbation?

A
  • more severe SOB & work of breathing
  • cough
  • purulent sputum / greater sputum volume
21
Q

What can cause a COPD exacerbation?

A
  • RTIs
  • HF
  • PE
  • medications: B-blockers, opioids, NSAIDs, MTX
22
Q

How is an exacerbation of COPD diagnosed?

A
  • low sats
    CXR - effusion, oedema
    ABG - worsening hypercapnia
    ECG - MAT
23
Q

What is MAT on an ECG?

A

Multifocal Atrial Tachycardia
- rapid, irregular, narrow QRS
- 3 different P-wave morphologies

(Complication of hypoxia as competing atrial foci, caused by B-agonists that act on B-1 receptors in heart = arrhythmias)

24
Q

How is COPD exacerbation managed?

A
  • O2 Tx - nasal cannula/venturi
  • Metered-dose inhalers + spacers / nebulisers - SABA + SAMA
  • Cortiicosteroids - IV methylpred / oral pred (5-7d)
  • Abx
  • mechanical ventilation if ARDS
25
Q

How is COPD medically managed (BTS)?

A

SABA/SAMA (as needed)

limited by symptoms
LABA + LAMA (LABA+ICS if asthmatic)

daily symptoms/multiple exacerbations
LABA + LAMA + ICS

Respiratory (15 decks)

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