COPD Flashcards by Shalika Devanarayana

COPD definition

Disease state characterized by airflow
limitation that is not fully reversible but
progressive with an abnormal inflammatory
response of the lung to noxious particles or
gases

How well did you know this?

Not at all

Perfectly

COPD is comprised of

Chronic bronchitis + emphysema

How well did you know this?

Not at all

Perfectly

difference between bronchitis and emphysema

Bronchitis is inflammation of large airways
emphysema is inflammation of alveoli

How well did you know this?

Not at all

Perfectly

Difference between COPD and asthma

COPD- Onset in mid-life
Symptoms slowly
progressive
Long smoking history
Largely irreversible
airflow limitations

Asthma- Onset early in life,
family history of
asthma
Symptoms vary from
day to day
Symptoms at
night/early morning
Allergy, rhinitis,
eczema also present
Largely reversible
airflow limitation

How well did you know this?

Not at all

Perfectly

Risk factors of COPD main two categories

Host factors
Environmental factors

How well did you know this?

Not at all

Perfectly

Host factors that affects COPD

Genes- alpha 1 antitrypsin deficiency
Gender- female smokers at higher risk
Lung growth- childhood infections, maternal infections

How well did you know this?

Not at all

Perfectly

Environmental factors that affect COPD

o Tobacco smoke
o Occupational dust- wood dust
o Pollution
o Infections
o Socioeconomic status

How well did you know this?

Not at all

Perfectly

Pathophysiology of COPD - central airways

mucus hypersecretion,
ciliary dysfunction → chronic cough, sputum
production

How well did you know this?

Not at all

Perfectly

Pathophysiology of COPD - peripheral airways

Airway remodelling, scar
tissue formation → fixed airway limitation,dynamic hyperinflation → low FEV1, high TLC,
rhonchi, barrel chest

How well did you know this?

Not at all

Perfectly

Pathophysiology of COPD - parenchyma

emphysema → loss of elastic
recoil, impaired gas exchange → low DLCO,
hypoxaemia

How well did you know this?

Not at all

Perfectly

Pathophysiology of COPD - vasculature

hypoxia →pulmonary
vasoconstriction → pulmonary hypertension
→ right ventricular hypertrophy (RAD< R in
V1, RBBB) → Right ventricular failure
(oedema, raised JVP, hepatomegaly)

How well did you know this?

Not at all

Perfectly

Hx in COPD

–
* chronic cough (intermittent or daily-cough
and sputum production for >3months,>2
years),
* chronic sputum production,
* breathlessness (progressive and
exertional),
* wheeze
* minimal day to day variation,
* worsening of symptoms with infections
* exposure to risk factors (smoking,
occupational dusts, smoke from home
cooking)

How well did you know this?

Not at all

Perfectly

Physical signs of COPD

usually late,
thin wasted person,
hyperinflation of chest, barrel shaped
chest, reduced cardiac dullness, liver
pushed down
Prolong expiration, B/L rhonchi on
auscultation,
cyanosis and polycythaemia,
oedema
cor-pulmonale

How well did you know this?

Not at all

Perfectly

Two clinical presentations of COPD

Blue bloaters
Pink puffers

How well did you know this?

Not at all

Perfectly

Blue bloaters Sx

Chronic, productive cough
Purulent sputum
Hemoptysis
Mild dyspnea (initially)
Cyanosis
Peripheral edema
Crackles, Wheezes
Prolonged expiration
Obese

How well did you know this?

Not at all

Perfectly

Pink puffers Sx

Dyspnea
Minimal cough
Increased minute ventilation
Pink skin, Pursed lip breathing
Accessory muscle use
cachexia
Hyperinflationm Barrel chest
Decreased breath sounds
Tachypnea

How well did you know this?

Not at all

Perfectly

Complications of blue bloaters

Secondary polycythemia vera due to hypoxemia
Pulmonary HTN due to reactive vasoconstriction from hypoxemia
Cor pulmonale from chronic pulmonary HTN

How well did you know this?

Not at all

Perfectly

Complications of Pink puffers

Pneumothorax due to bullae
Weight loss due to work of breathing

How well did you know this?

Not at all

Perfectly

FEV1/FVC ratio of COPD

<70% ( Obstructive disease)

How well did you know this?

Not at all

Perfectly

FEV1 level in COPD

<80% predicted

How well did you know this?

Not at all

Perfectly

TLC, FRC, RV

Increased

DLCO levels in COPD

Reduced

DDs of COPD

Long standing breathlessness –
1. chronic persistent asthma, chronic
heart failure
Chronic cough – bronchiectasis,
tuberculosi

Management of COPD

Diagnose, assess, monitor
Reduce risk factors
Manage stable COPD
Management of exacerbation
o Controlled oxygen through mask
o Nebulized bronchodilators (salbutamol,
ipratropium
o Antibiotics
o Oral prednisolone – 40 mg/day

Pulmonary rehabilitation

Education and training program to help patient to live an active life within the limitation of symptoms

Pulmonary rehabilitation

* Stopping smoking * Controlling breathlessness o Breathing control o Pursed lip breathing o Correct posture * Stopping smoking * Controlling breathlessness o Breathing control o Pursed lip breathing o Correct posture

Complications of COPD

* recurrent exacerbations by URTI, * cor-pulmonale, * type II respiratory failure, * pneumothorax, * polycythaemia * systemic effects (muscle wasting, muscle fatigue

MMRC dyspnea scale

0 - vigourous exertion 1- rapid walking / climbing uphill 2- normal speed wailking 3- 100m / few minutes of level ground walk 4- Stationary activity – dressing, undressing etc. Can’t leave home

CAT ( COPD assessment tool)

score each from 0-5 (good - 0 to worst -5) 1. Cough 2. Sputum 3. Chest tightness 4. Dyspnoea 5. ADL 6. Sleep 7. Confidence in walking out 8. Energy

Dx steps in COPD

1. Spirometrically confirmed Dx - Post bronchodilator FEV1/FVC <70% 2. Assessment of airflow limitation - Predicted FEV1 GOLD 1 >= 80 GOLD 2 50-79 GOLD 3 30-49 GOLD 4 <30 3. Assessment of Sx/risk of exacerbations - table

Assessment of Sx/ risk of exacerbations. Y axis and X axis

Y axis - exacerbation Hx X axis - Sx

Y axis

0 or 1 (not leading to hospital admission) >=2 or >=1 leading to hospital admission

X axis

mMRC 0-1 and CAT <10 mMRC >=2 and CAT >=10

Group A in COPD Mx

mMRC 0-1 CAT <10 0-1 exacerbations and no hospital admissions

Group B in COPD Mx

mMRC >=2 CAT >=10 0-1 exacerbations and no hospital admissions

Group C in COPD Mx

mMRC 0-1 CAT<10 >=2 or >=1 w hospital admission

Group D COPD Mx

mMRC >=2 CAT >=10

Group B Drugs COPD

LAMA or LABA persistent Sx LAMA+LABA

Group A Drugs in COPD

LAMA or LABA evaluate the effect Continue, stop or try alternative class or bronchodilator

Group C drugs COPD

LAMA further exacerbations LAMA+LABA or LABA+ICS

Group D drugs COPD

Start w LAMA further exacerbations LAMA+LABA or LABA+ICS further worsening LAMA+LABA+ICS further exacerbations Consider Roflumilast (if FEV1 <50% predicted and pt has chronic bronchitis) OR Consider Macrolides (in former smokers)

When to consider LTOT for COPD

if PaO2 <55mmHg Should be given at least 15h/d

Mortality benefit in COPD

Cessation of smoking Long term O2 therapy Lung vol reduction therapy

Indications of NIV for COPD exacerbations

PaCO2 >45mmHg Persistent hypoxia despite other exacerbation measures Clinical severe dyspnea w progression to exhaustion

Pack years calculation

(No of Cig smoked per day/ 20) x No of years smoked

Barrel chest

AP diameter > transverse

How does COPD cause the right heart to fail

In alveoli that are not adequately oxygenated, blood supply for perfusion will not happen. BV will undergo vasoconstriction. (Coz there's no point sending blood to these alveoli) This causes pulm HTN ( causes RVH coz of extra pressure in RV) RVH causes RAD ( tall wave in V1) At some point, R heart will fail ( Ascites, Edema, increases JVP, Hepatomegaly)

meaning behind Pink puffers

usually in people increasing CO2 levels stimulate the respi centre in the medulla. But in pink puffers, hypoxia stimulates the respi centre, so they are always gasping for breaths. Therefore, they are not cyanosed.

meaning behind blue bloaters

they are not sensitive to hypoxia. ( Respi centre is not stimulated by hypoxia) so they are not cyanotic. Kidneys will also undergo hypoxia. Renal hypoxia will trigger RAAS. causing Sodium- water retention giving edema

% of controlled oxygen given in COPD and the target SpO2

25-28% target SpO2 - 88-92%