COPD Flashcards
Presentation of COPD?
Smoker, chronic sob, cough, sputum production, wheeze, recurrent respiratory infections particularly in winter
Right sided heart failure- peripheral oedema
Dyspnoea scale?
1- sob on strenuous exercise
2-sob when walking up hill
3-sob on walking flat
4-stop to catch breath at 100m
5- unable to leave house
Diagnosis of COPD is based on?
Clinical presentation and spirometry
Severity determined by FEV1?
- > 80
- 50-79
- 30-49
- Less than 30
What is alpha 1 anti trypsin deficiency?
Lack of protease inhibitor produced by liver, which protects cells from neutrophil elastase.
COPD in young people, non smokers.
A1AT gene found on?
Chromosome 14, autosomal recessive-co dominant
PiZZ genotype
What do you see in A1AT?
Panacinar emphysema- lower lobes
Cirrhosis and hepatocellular carcinoma and cholestasis in children
Management specific to A1AT?
Bronchodilators, IV alpha1 antitrypsin protein concentrates, lung volume reduction surgery, lung transplantation
What else is decreased in COPD?
Transfer factor for carbon monoxide TLCO. Can be increased in asthma
Management of COPD?
- SABA or SAMA
- If no asthmatic or steroid responsive features then LABA plus LAMA
- If steroid responsive/ asthmatic- LABA plus ICS, if this doesn’t work then LABA/LAMA and ICS
In severe cases nebulisers, oral theophylline, oral mucosa tic therapy carbocisteine, prophylactic Ab azithromycin and long term oxygen
ABGs of COPD?
Respiratory acidosis, retaining CO2
Medical treatment of exacerbation?
At home: prednisolone 30mg 7-14 days, inhalers/nebulisers, antibiotics
Hospital: nebuliser bronchodilators, steroids, antibiotics, physiotherapy
Severe cases: IV aminophylline, non invasive ventilation. Intubation and ventilation, doxapram (respiratory stimulant)
COPD causes?
Smoking, A1AT, cadmium, coal, cotton, cement, grain
CXR of COPD?
Hyperinflation, flat hemidiaphragm, Bullae (air space in lung)
Who should be put on oxygen?
FEV1 less than 30, consider if between 30-49
Polycythaemia
Peripheral oedema
Cyanosis
Raised MVP
Oxygen sats less than 92
Offer LTOT to:
Oxygen sats less than 7.3 or between 7.3 and 8 with polycythaemia, p oedema or pulmonary hypertension
For smoking offer?
Nicotine replacement therapy, bupropion, varenicline
Don’t coprescribe theophylline with?
Macrolide (azithromycin) or fluoroquinolone (levofloxacin)
What can azithromycin do?
Prolong QT interval
For peripheral oedema, cor pulmonary enzymes what should you use?
Loop diuretics
In COPD which inflammatory markers are released?
Leukotriene B4, IL8 and TNF alpha
Paraseptal emphysema affects?
Distal alveoli- periphery of lobules- can rupture and cause pneumothorax
Pink puffers?
Pursed lip breathing to maintain pressure in airways
On CXR air trapping can cause?
Hyperinflation, barrel chest so increased anterior to posterior diameter, increased radiolucency
