COPD Flashcards
what is the first line management for COPD?
short-acting beta-agonist (e.g. salbutamol) or short-acting muscarinic-antagonist (e.g. ipratropium)
what are the classical examination findings for COPD?
- reduced crico-sternal distance <3cm
- hyper-resonant percussion note
- use of accessory muscles for respiration
what are the criteria for long-term oxygen therapy in COPD?
clinically stable non-smokers with PaO2 <7.3 (~O2 of 88%) measured at least twice, a minimum of 3 weeks apart, despite maximum treatment
OR
Pa O2 7.3-8 + one of the following:
* pulmonary hypertension
* nocturnal hypoxaemia
* secondary polycythaemia
* terminally ill patients for palliation
what causes COPD?
smoking
what single intervention is most likely to improve COPD prognosis?
smoking cessation
what ECG changes can be seen in COPD?
- R axis deviation
- prominant P waves in inferior leads
- inverted P waves in high lateral leads (I, aVL)
- low voltage QRS
- delayed R/S transition in leads V1-V6
- P pulmonale
- right ventricular strain pattern
- RBBB
- multifocal atrial tachycardia
what is the ‘blue bloater’ phenotype in COPD?
chronic bronchitis + hypoxaemia
patients are under-ventilated (due to chronic airway inflammation and reduction in RR) therefore increased energy is requred to get air through narrowed airways. cardiac output is increased to compensate.
leads to low V/Q ratio (decreased ventilation)
what is COPD?
- chronic bronchitis = hypertrophy and hyperplasia of the mucus glands in the bronchi
- emphysema = enlargement of the air spaces and destruction of alveolar walls
how do you diagnose chronic bronchitis?
chronic productive cough for at least 3 months in at least 2 consecutive years without other identifiable causes
what are the clinical features of chronic bronchitis?
- chronic productive cough
- purulent sputum production
- hypoxia
- hypercapnia
- exertional dyspnoea
- cyanosis (‘blue bloaters’)
- peripheral oedema secondary to cor pulmonale
what investigation should be carried out in a young patient with severe emphysema?
alpha1-antitrypsin
what are the clinical features of emphysema?
- carbon dioxide retention
- pursed lip breathing
- extertional dyspnoea
- use of accessory muscles in breathing
- barrel chest (hyperexpanded chest)
- hyperresonant chest on percussion
- sits forward in hunched-over position
what are the symptoms of COPD?
- productive cough
- wheeze
- dyspnoea
- reduced exercise tolerance
what is a typical pattern of spirometry in COPD?
irreversible obstructive spirometry (un-reversed upon salbutamol inhaler)
FEV1 <80% + FEV1/FVC <0.7
how do you classify the stages of COPD?
- stage 1 (mild) = FEV1 >80%
- stage 2 (moderate) = FEV1 50-79%
- stage 3 (severe) = FEV1 30-49%
- stage 4 (very severe) = FEV1 <30%
what is typically seen on ABG from COPD patient?
type 2 respiratory failure
reduced PaO2 +/- raised PaCO2
what oxygen saturations should you aim for in a patient with COPD?
88-92%
what is the criteria for lung volume reduction surgery?
upper lobe predominant emphysema
FEV1 >20%
PaCO2 <7.3
TICO >20%
what therapy should be given to COPD patients with co-existing asthma/atophy?
long acting B2 agonist (e.g. formoterol) + inhaled corticosteroid (e.g. budesonide)
what is step 1 of the pharmacological management of chronic COPD?
SABA (e.g. salbutamol) + SAMA (e.g. ipratropium)
what is step 2 of the pharmacological management of chronic COPD?
persistent exacerbations but no asthmatic features
LABA (e.g. salmeterol) + LAMA (e.g. tiotropium)
what is step 3 of the pharmacological management of chronic COPD?
LAMA (e.g. salmeterol) + LABA (e.g. tiotropium) + ICS (e.g. beclomethasone)
what is the best mask to delivery oxygen in type 2 respiratory failure?
venturi mask
can deliver fixed % FiO2 and avoid CO2 retention
