COPD Flashcards
What is it? The Two Forms of COPD
A long term respiratory condition which is treatable (but not curable). It is characterised by airflow obstruction that is not fully reversible and is usually progressive
- Emphysema
- Chronic Bronchitis
Causes of COPD
- Smoking (most common)
- Asthma - uncontrolled over a long period can lead to COPD
- Infections - TB can cause COPD
- Pollution and fumes - air pollution, chemical fumes, dusts or toxic substances
- Genetics
Causes of Exacerbation of COPD
- Any virus or infection
- Pollutants; NO2, CO, SO2, O3
Signs and Symptoms of Normal COPD
- Exertional breathlessness
- Chronic cough
- Regular white/clear sputum productions
- Frequent winter ‘bronchitis’
- Wheeze
What is Type 2 Respiratory Failure in COPD Patients?
- COPD patients are at a higher risk of hypercapnic respiritory failure and respiratory acidosis due to carbon dioxide retension
- Hence it is important for us to know their baseline
What is Chronic Bronchitits and how it relates to COPD
- It is one of the forms of COPD
- Airway problem where airways become inflamed becoming partly blocked from swelling or mucus, you can cough up the phlegm
What is Emphysema and how it realted to COPD
The alveoli sacs become enlarged or damaged, making gas exchange difficult and casing DIB
The Two forms of VQ Mismatch
V = ventilation
Q = perfusion
Shunting - good blood flow with poor ventilation
Dead Space - inadequate blood flow but lots of O2 eg a PE
Pathophysiology of Exacerbation
- Can be triggered by a range of factors including infections, smoking, environmental pollutants
- Many exac not caused by bacteria pt won’t respond to antibiotics
- Is assc w/ increased airway and systemic inflammation and physiological changes, especially the development of hyperinflation.
- Productive cough caused by the damage to the cilia cells
- Dmg to cilia also means ability to clear mucus is reduced
- Chronic inflammation causes scarring to the alveoli, and small airways
Signs and Symptoms of Exacerbation; Moderate
- Worsening breathlessness at rest or on exertion
- Tiredness
- Repeated chest infections/cold symptoms
- Chest tightness
- Increased wheezing
- Increased cough and sputum production
- Fluid retention
- New or worsened confusion
Signs and Symptoms of Exacerbation; Severe
- Severe dyspnoea
- Tachypnoea
- Acute confusion
- Accessory muscle use
- Increased/cyanosis
- New/worsened oedema
- Acute confusion
History for COPD Patients
- Determine baseline sats
- Any hx of infection
- Any rescue medications they have/taken
- Any home oxygen?
What are COPD Alert Cards?
- Patient may have an alert card on that tells you their normal O2 levels
- May tell you specific emergency treatment
- May contain messages from the GP
- Can detail specific breathing techniques and control eg fans, pursed lip breathing
What are the Hypoxic Drive Considerations?
- The 6 minutes limit is to avoid the hypoxic drive when over-oxygenating patients such as COPD. Occasionally it will mean the patient will drop their resps due to the over-oxygenating. Non COPD patients, completely ignore.
- If in acute/serious setting then approach with caution but do not disregard completely.
- Studies show respiratory depression only occurs in long term so consider if long run time to hospital and monitor closely
What Can Excessive Oxygen Administration Lead to in COPD Patients?
- Increased difficulting in reducing hypoxic pulmonary vasocontriction reflex due to worsening VQ mismatch
- Decreased binding affinity of haemoglobin for carbon dioxide
- Decreased minute ventilation (dropped resps)
Conditions for Home Treatment and Refferal
- Able to cope at home
- Mild breathlessness
- Good general condition
- Good mobility and lvl of movement
- No cyanosis or worsening peripheral oedema
- Normal lvls of consciousness
- Not already receiving home O2
- No new or worsening confusion
- SpO2 above 90%
Conditions for Hospital Admission
- Unable to cope at home
- Severe breathlessness
- General conditioning is poor or deteriorating
- Signs of cyanosis or have worsening peripheral oedema
- Impaired levels of consciousness
- Not coping at home
- New or worsening confusion
- Significant co-morbidities eg insulin-dependant diabetics
- SpO2 below 90%
What Drugs can we give in Exacerbation of COPD
- Salbutamol
- Ipratropium Bromide
- Hydrocortisone
- Rescue meds*
Rescue Meds for COPD
Medications such as amoxicillin is a broad-spectrum antibiotic that is prescribed as a rescue medication in cases of symptoms of infection
List of COPD Differentials
- Pneumonia
- Pulmonary Oedema
- PE
- Pleural Effusion
- Reccurent aspiration
- Asthma
- Pneumothorax
