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COPD Flashcards

1
Q

What is COPD?

A

Chronic obstructive pulmonary disease is a long term, progressive condition involving airway obstruction, chronic bronchitis, and emphysema

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2
Q

What is chronic bronchitis?

A

Long term symptoms of a cough and sputum production due to inflammation in the bronchi

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3
Q

What is emphysema?

A

Damage and dilation of the alveolar sacs, decreasing the surface area for gas exchange

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4
Q

What are the causes of COPD?

A

SMOKING
Environmental causes:
- Cadmium (smelting)
- Coal
- Cotton
- Cement
- Grain

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5
Q

What are the features of COPD?

A

Cough - productive
Dyspnoea
Wheeze
Recurrent respiratory infections

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6
Q

What symptoms does COPD NOT cause?

A

Clubbing
Haemoptysis
Chest pain

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7
Q

What is the MRC dyspnoea scale?

A

Grade 1 - breathless on strenuous exercise
Grade 2 - breathless on walking uphill
Grade 3 - breathlessness that slows walking on the flat
Grade 4 - breathlessness that stops them from walking 100m on flat
Grade 5 - unable to leave house due to breathlessness

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8
Q

How is the severity of COPD graded?

A

Stage 1 - FEV1 more than 80% of predicted
Stage 2 - FEV1 50-79% of predicted
Stage 3 - FEV1 30-49% of predicted
Stage 4 - FEV1 < 30% predicted

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9
Q

How is COPD diagnosed?

A

Diagnosis based on clinical presentation and spirometry results

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10
Q

What will be seen on spirometry in a patient with COPD?

A

Obstructive picture
- FEV1:FVC ratio of less than 70%

Little to no response to reversibility testing with beta-2 agonists

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11
Q

What other investigations may be helpful in diagnosis of COPD?

A

CXR - rule out other lung pathology
FBC
Sputum culture - assess for chronic infection
ECG - heart failure and cor pulmonale
CT thorax - fibrosis, cancer or bronchiectasis

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12
Q

What is seen on CXR in COPD?

A

Hyperinflation
Bullae - air filled spaces in the lungs
Flat hemidiaphragm

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13
Q

What vaccines should patients with COPD have?

A

Pneumococcal
Annual flu vaccine
Annual covid vaccine

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14
Q

What is the initial management of COPD?

A

SABA
SAMA e.g ipratropium bromide

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15
Q

What criteria determine asthma/steroid responsive features?

A

Previous diagnosis of asthma or atopy
Raised blood eosinophil count
Variation in FEV1 of more than 400ml
Diurnal variability in peak flow of more than 20%

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16
Q

What is the second line treatment when there is asthmatic or steroid-responsive features?

A

A combination of:
- LABA
- ICS

17
Q

What is the second line treatment where there are asthmatic/steroid responsive features present?

A

Combination of:
- LABA
- LAMA

18
Q

What is the third line management of COPD?

A

Combination of:
- LABA
- LAMA
- ICS

19
Q

What antibiotic is used in some patients as prophylactic therapy?

A

Azithromycin

20
Q

What are the criteria for azithromycin antibiotic therapy?

A

Non-smoker
Optimised standard treatments
Continues exacerbations
CT thorax and sputum culture
LFTs
ECG to exclude QT prolongation

21
Q

Which patients may receive long term oxygen therapy?

A

Severe COPD with chronic hypoxia (<92%)
Polycythaemia
Cyanosis
Cor pulmonale

22
Q

What is cor pulmonale?

A

Right-sided heart failure due to respiratory disease

23
Q

What are the causes of cor pulmonale?

A

COPD - most common
PE
Interstitial lung disease
CF
Primary pulmonary hypertension

24
Q

What are the symptoms of cor pulmonale?

A

Dyspnoea
Peripheral oedema
Breathlessness on exertion
Syncope
Chest pain

25
Q

What are the signs of cor pulmonale on examination?

A

Hypoxia
Cyanosis
Raised JVP
Peripheral oedema
Parasternal heave
Loud second heart sound
Murmurs
Hepatomegaly

26
Q

What may be seen on a blood gas in acute COPD exacerbation?

A

Respiratory acidosis
- Low pH
- Low pO2
- Raised pCO2
- Raised bicarbonate - chronic retention

27
Q

What other investigations are useful in an acute exacerbation of COPD?

A

CXR
ECG
FBC
U&E
Sputum culture
Blood cultures

28
Q

What are the target sats for a COPD patient who are at risk of retaining CO2?

A

88-92%

29
Q

What are the normal target sats for a patient with COPD?

A

94-98%

30
Q

What is the first line medical treatment of an acute exacerbation of COPD?

A

Regular inhalers and nebulisers
Steroids (prednisolone 30mg OD for 7 days)
Antibiotics

31
Q

When is NIV considered in acute exacerbation of COPD?

A

Persistent respiratory acidosis despite maximal medical treatment

Extra Revision (28 decks)

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