COPD Flashcards
Signs and symptoms of COPD
CO retention flap
Tripod stance
Reduced pO2
Bounding pulse - co2 retention
Bruising from steroid use
Crackles
What heart condition do you need to look for in COPD
Cor pulmonale - where pulmonary hypertension results in right sided heart failure
Signs of cor pulmonale
Raised JVP
Hepatomegaly
Parasternal heave
Loud pulmonary second heart sound
What is FEV1 vs FVC
FEV1 - exhalation in 1 second
FVC - how much you can exhale totally after inhalation
Normal FEV1 and normal FVC
Over 80 percent
Normal FEV1 to FVC ratio
Over 70 percent
How can you compare obstructive vs restrictive lung diseases?
The FEV1 to FVC ratio would be normal in restrictive disease, as both are reduced individually.
In obstructive, the ratio would be reduced because FVC is normal/only slightly reduced.
Asthma vs COPD FEV1 to FVC
Asthma - reversible
COPD - not reversible, ratio under 70 percent
How do you classify COPD
Mild - FEV1 over 80
Moderate - FEV1 - 50-80
Severe - 30-50
Very severe - under 30
In COPD, what x ray changes do you see and why?
Hyperexpansion - look for whether the diaphragm looks flat, and if the diaphragm is being intersected by ribs 5-7 of the anterior (curved) ribs.
The lower border of the heart may be seen as floating
Bullae - black spaces
Management of COPD
- SABA or SAMA
- LABA and LAMA or LABA and ICS
- LABA, LAMA, ICS
What is SAMA
short acting muscarinic antagonist - e.g. ipratropium bromide
Give an example of a LABA ICS combo
Symbicort - formoterol plus budesonide
Give examples of non-inhaled therapies
Mucolytic such as carbocysteine
Theophylline
Give examples of non pharmacological management of COPD
Smoking cessation
Pulmonary rehab
Pneumococcal/influenza vaccines
Lung transplant
Give examples of oxygen therapy in end stage COPD
Long term oxygen therapy = LTOT
Ambulatory home oxygen therapy - if only hypoxemic on extertion
When would you prescribe LTOT
If the pO2 was below 7.3 kPa (55mmHg, normal range is 75-100mmHg)
or below 8 with pulmonary HTN, pulmonary oedema or secondary polycythemia
When would you prescribe ambulatory home oxygen therapy?
If hypoxemic on exertion only
How much oxygen can be delivered via a nasal cannula
up to 2 L
What is the oxygen delivery system between a nasal cannula and a venturi face mask and how much can it deliver?
Hudson normal face mask - 6 L
What are the venturi mask colours
Bullies - Blue - 2-4 L
Want - White - 4-6L
Your - Yellow - 8-10 L (not 6)
Ripe - Red - 10-12 L
Grapes - 12 - 15 L
How do you manage acute COPD exacerbation
Oxygen
Nebulised salbutamol 2.5mg/4 hours
Steroids - 30mg prednisolone or 200mg hydrocortisone
Antibiotics
Chest physio
BiPAP if hypercapnic acidosis and not responding to mx in 1 hr
IV aminophylline
ITU
When do you consider ITU in someone with COPD
If pH is below 7.26
