COPD Flashcards
how would you diagnose COPD
History (symptoms & risk factors)
Examination
Chest x-ray
Spirometry
- there is no gold standard test
COPD - Symptoms
Breathlessness
Cough
Sputum
Frequent chest infections
Wheeze
what should COPD examination include
- Vital signs (RR, O2 sats)
- General exam (cyanosis, tar staining, etc.)
- Chest exam (hyperinflated chest, crackles, wheeze, etc.)
COPD - Differential Diagnosis
Asthma
Lung cancer
Tuberculosis
Bronchiectasis
Left heart failure
Interstitial lung disease
Cystic Fibrosis
Idiopathic Cough
Who gets COPD?
Smokers
Older adults
Deprived populations
Manage Co-morbidities such as
Heart failure
Ischaemic heart disease
Obesity
Interstitial Lung Disease
Bronchiectasis
Management of COPD
- vaccinations
- pulmonary rehabilitation
- manage co-morbidities
- Pharmacological Management
Pharmacological Management
Bronchodilators
Inhaled Corticosteroids
Combination therapies
Oral therapies
An exacerbation of COPD is defined as
an acute worsening of respiratory symptoms that results in additional therapy
what is the recommended initial management of COPD exacerbations
bronchodilators
Systemic steroids
can improve lung function, oxygenation and shorten recovery time. Duration of therapy should be not more than 5 days
Antibiotics, when indicated, can
shorten recovery time, reduce the risk of early relapse, treatment failure. Duration of therapy should be 5 days.
Who to refer to Secondary Care?
Diagnosis uncertain
Rapidly declining FEV1
For consideration of:
- Lung Volume Reduction Surgery
- Bronchoscopic Valves
- Lung Transplant
Anticipatory Care
By the time patients get to secondary care for their COPD, their outcome is poor
Most patients are
- Elderly
- Frail
- Have significant co-morbidities
Palliation of Breathlessness
- Not the same as hypoxaemia
A fan is the most useful intervention
Anxiolytics
Lorazepam 0.5mg PRN
Oral liquid morphine 1mg PRN
Pulmonary rehabilitation
