COPD Flashcards
Define COPD
Chronic, progressive lung disorder characterised by airflow obstruction with:
Chronic bronchitis: continuous cough + sputum production for >, 3 months over 2 years
Emphysema: pathological destruction of air spaces in terminal bronchioles
What is bronchial and alveolar damage caused by?
Environmental toxins e.g. cigarette smoke
What is a rare cause of COPD? When should this be considered?
Alpha 1 antitrypsin deficiency
In young patients / people who have never smoked.
Give 4 characteristics of chronic bronchitis
Narrowing of the airways resulting in bronchiole inflammation (bronchiolitis)
Bronchial mucosal oedema
Mucous hypersecretion
Squamous metaplasia
What characterises emphysema?
Destruction + enlargement of alveoli
Loss of elasticity that keeps small airways open in expiration
Progressively larger spaces develop called bullae (diameter > 1 cm)
Summarise the epidemiology of COPD
8% prevalence
Presents in middle age or later
M > F: may change due to rise in female smokers
List 5 symptoms of COPD
Chronic cough Sputum production Breathlessness Wheeze Reduced exercise tolerance
List 5 signs found on inspection of a patient with COPD
Respiratory distress Use of accessory muscles Barrel-shaped over-inflated chest Decreased cricosternal distance Cyanosis
List 2 signs found on percussion of a patient with COPD
Hyper-resonant chest
Loss of liver + cardiac dullness
List 5 signs found on auscultation of a patient with COPD
Quiet breath sounds Prolonged expiration Wheeze Rhonchi - rattling, continuous + low-pitched breath sounds (likened to snoring, due to secretions in larger airways or obstruction) Sometimes crepitations
What are the signs of CO2 retention? What signs may present in late stages?
CO2 retention flap Bounding pulse Warm peripheries LATE STAGES: signs of right heart failure- RV heave Raised JVP Ankle oedema
What would be found on spirometry testing and pulmonary function testing of a patient with COPD?
Reduced PEFR
Reduced FEV1/FVC
Increased lung volumes
Decreased carbon monoxide gas transfer coefficient
Describe CXR findings of a patient with COPD
May appear NORMAL
Hyperinflation (> 6 anterior ribs in MCL at diaphragm level, flattened diaphragm)
Reduced peripheral lung markings
Elongated cardiac silhouette
What blood test is needed in COPD and why?
FBC: increased Hb + haematocrit due to secondary polycythaemia
What may be seen on an ABG of a patient with COPD?
Hypoxia
Normal/ raised PCO2
Why perform an ECG and echocardiogram on a COPD patient?
To check for cor pulmonale
COPD can cause pulmonary HTN
When are blood and sputum cultures useful in COPD?
Acute infective exacerbations
What would you measure in a young patient who had never smoked if you suspected COPD?
Alpha 1 antitrypsin levels
List 3 bronchodilators that can be used in the management of COPD
SABAs (e.g. salbutamol)
Anticholinergics (e.g. ipratropium bromide)
LA beta-2 agonists (if > 2 exacerbations per year)
Describe steroid usage in the management of COPD
Inhaled beclamethasone: considered in all patients with FEV1 < 50% of predicted OR > 2 exacerbations per year
Regular oral steroids avoided if possible
List 3 other management strategies used for COPD
Prevent infective exacerbations: pneumococcal + influenza vaccination
Pulmonary rehabilitation
Oxygen Therapy: used if PO2 <7.3 during clinical stability
What advice is often given to a patient with COPD?
STOP SMOKING
List 6 possible complications of COPD
Acute respiratory failure Infections Pulmonary HTN Right heart failure Pneumothorax (secondary to bullae rupture) Secondary polycythaemia
Summarise the prognosis of a patient with COPD
High morbidity
3y survival rate ~ 90-75% depending on FEV1:FVC.
