COPD Flashcards
what is the definition of COPD?
- Fixed airflow obstruction
- Minimal/no reversibility with bronchodilators
mostly due to smoking
describe the epidemiology:
2nd most common, after asthma
prevalence increases with age
list 9 aetiological factors:
Tobacco smoking (95%)
Air pollution
exposure to dust or fumes due to job
Gender (more common in females)
age
Childhood disadvantage factors
Low social-economic status
Pre-existing pathologies, e.g. asthma, chronic bronchitis
Alpha-1 Antitrypsin Deficiency (inherited deficiency - rare)
what is the pathology of COPD?
Mucous gland hyperplasia in the large airways with associated increased mucous secretion
-> chronic cough.
Squamous metaplasia -> normal ciliated columnar epithelium replaced with squamous epithelium.
Loss of cilial function - impairs clearance from the lung
Chronic inflammation and fibrosis of small airways with inflammatory cell infiltration
Emphysema - alveolar wall destruction and irreversible enlargement of airways distal to the terminal bronchiole
- Also, there is a loss of elastic recoil and hyperinflated lungs.
Cor pulmonale - vasoconstriction of pulmonary arteries due to hypoxia, shunts blood flow.
state common and other symptoms of COPD:
Common:
cough
breathlessness
sputum
frequent chest infections
wheezing
Other:
fatigue
swollen ankles
weight loss
state clinical features of COPD:
Breathlessness
Chest wall deformities (barrel chest)
Pursed lip breathing
Cyanosis - bluish discolouration mouth or periphery - due to hypoxia
Wheeze
state late-stage COPD clinical features:
Peripheral oedema
Raised JVP (jugular vein pressure)
Cachexia (severe weight loss)
what is the criteria to follow when diagnosing COPD?
Typical symptoms
> 35 years
Presence of risk factor (smoking or occupational exposure)
Absence of clinical features of asthma
Importantly:
o Airflow obstruction confirmed by post-bronchodilator spirometry
what are 4 investigations used to diagnose COPD?
- Spirometry (FEV1/FVC <0.7)
- Minimal bronchodilator reversibility
-↑ total lung volume & residual volume
- Consider checking α1-antitrypsin levels
how is spirometry in COPD differ from asthma?
In asthma,
Spirometry may be normal
Reversible
In COPD,
FEV1/FVC < 0.7
Lack of reversibility
describe clinical features differentiationg COPD and asthma:
COPD:
- all are smokers
- all over 35
- chronic productive cough
- persistant and progressive cough
- no waking up with breathlessness
- no day to day variability of symptoms
Asthma
- not smokers
- under 35
- no chronic productive cough
- variable breathlessness
- waking up with breathlessness
- day to day variability of symptoms
describe how to assess the severity of COPD:
Stage 1, mild — FEV1 80% of predicted value or higher.
◦ Stage 2, moderate — FEV1 50–79% of predicted value.
◦ Stage 3, severe — FEV1 30–49% of predicted value.
◦ Stage 4, very severe — FEV1 less than 30% of predicted value
List some of the investigations used in the assessment of a COPD exacerbation in hospital
full blood count
theophylline concentraion
arterial blood gas
chest x ray
ECG
sputum culture
what are 4 non-pharmacological management techniques?
- Smoking Cessation
- Vaccinations
– influenza (Flu) vaccine
– Pneumococcal vaccine - Pulmonary Rehabilitation
- Diet/ Exercise
- Psychological support
describe the management of COPD in primary care:
short acting bronchodilator
- SABA (salbutamol) and SAMA (ipratropium)
- use nebulisers if can’t use inhalers
corticosteroids
- prednisolone 40mg for 5-7 days
antibiotics for exacerbations or evidence of infection (fever, increased sputum)
hospital admission if:
low oxygen saturation
hypotension
describe the management of acute exacerbation of COPD in the hospital?
Oxygen - target Saturation 88-92%
Nebulised bronchodilators
Corticosteroids
Antibiotics (Oral Vs IV)
