COPD Flashcards
Define COPD?
Chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible.
Its common, preventable and treatable
What is the prevalence and incidence of COPD?
Prevalence = increasing
- greater in males than females (due to different jobs and smoking habits)
Incidence = decreasing
- possibly due to increased cessation of smoking
How can COPD be caused (aetiology)?
Smoking
- may affect foetal lung growth and priming of the immune system
- <50% will develop COPD
Occupation
- exposure to dust and fumes
Genetic
- Alpha-1-antitrypsin deficiency = early onset of COPD <45 years
Childhood disadvantage
- shunted lung development increases risk
Lower socioeconomic group
Asthma/airway hyperreactivity
Chronic bronchitis
Childhood infection
What is the patho-biology of COPD?
Impaired lung growth
Accelerated decline
Lung injury
Lung and systematic inflammation
What is the pathology of COPD?
Small airway disorders
Abnormalities
Emphysema
Systemic effects
What are the symptoms of COPD?
Cough
SOB
Sputum
Frequent chest infections
Wheezing
Other:
- Weight loss - due to inc metabolic activity
- Fatigue
- Swollen ankles
- Depression, anxiety
Upon examination what could a COPD patient present with?
Cyanosis (blue)
Raised JVP
Cachexia
Wheeze
Pursed lip breathing
Hyperinflated chest
Use of accessory muscles
Peripheral oedema
When do you diagnose COPD?
Typical symptoms
>35 years old
Presence of a risk factor (e.g. smoking)
Absence of clinical features of asthma
AND
Airflow obstruction confirmed by lung function tests
What does a chest x-ray show
Vascular hila (more prominent)
Hyperinflation (>6 anterior ribs showing)
Bulla (reduced lung markings)
Small heart (squashed by lungs)
Flat diaphragm
What does spirometry results show?
80% predicted = mild
50-70% = moderate
30-49% = severe
<30% = very severe
*useful but not always diagnosis
What are the differences between COPD and asthma?
COPD
- Smoker = nearly all
- Rarity to have symptoms under 35
- Common chronic productive cough
- Uncommon night time waking with SOB and wheeze
- Persistent SOB
- Uncommon variability
Asthma
- Possible smoker
- Often symptoms under 35
- Uncommon chronic productive cough
- Variable SOB
- Common nocturnal variability
How to manage acute exacerbations in primary care?
Change inhalers (technique, device, add bronchodilator, increase or add inhaled steroid)
Oral steroids
Antibiotics
Self management for select patients
When do acute exacerbations need hospital treatment?
Confusion
Cyanosis
Severe SOB
Flapping tremor
Drowsy
Pyrexial
Wheeze
Tripod possition
Tachypnoea
Low O2 sats (<90-92%)
Hypotension
How to manage acute exacerbations in secondary care?
Oxygen
Nebulised bronchodilator
(B2 & anti-muscarinic)
Oral/IV corticosteroid
Oral/IV antibiotics
Ventilation
What investigations are done in secondary care?
CXR
Blood gases
FBC
U&E
Sputum culture
VTS