COPD Flashcards
What is COPD?
Refers to a progressive, irreversible lung disease characterised by airway obstruction.
Two types:
- Chronic bronchitis
- Emphysema
What is chronic bronchitis?
Involves hypertrophy and hyperplasia of the mucus glands in the bronchi.
What is emphysema?
Involves enlargement of the air spaces and destruction of alveolar walls.
Risk factors of COPD?
Smoking (active and passive)
Occupational exposure to dust
Alpha-1 antitrypsin deficiency
Prognosis worsened:
Older age
Ongoing smoking
Reduced body weight
Low FEV1
Presentation of COPD?
Productive cough (frothy white to slightly yellow/green)
Recurrent respiratory infections
Wheeze
Dyspnoea
Reduced exercise tolerance
Weight loss
Accessory muscle use
Prolonged expiratory phase
Pursed lip breathing
Tachypnoea
Cyanosis
Cor pulmonale (signs of right heart failure -distended JVP and peripheral oedema)
Hyperinflation – reduction of the cricosternal distance
Reduced chest expansion
Hyper-resonant percussion
Decreased/quiet breath sounds
Wheeze
IVx for COPD?
FBC (polycythaemia due to chronic hypoxia)
ABG (reduced paO2 +/– raised paCO2)
ECG
- P-pulmonale (right atrial hypertrophy)
- Right ventricular hypertrophy (if cor pulmonale present)
CXR
- Hyperinflated chest (>6 anterior ribs)
- Bullae
- Decreased peripheral vascular markings
- Flattened hemidiaphragms
Spirometry with a bronchodilator reversibility (no improvement)
- FEV1/FVC ratio <0.7
- increased total lung capacity (TLC)
- Low TLCO (significant emphysema)
- severity depends on FEV1
Other tests:
- Sputum culture (exacerbating organism)
- BNP + echocardiogram (assess for HF)
- Serum alpha-1 antitrypsin
- high-resolution CT
Severity scale for COPD?
Stage 1: FEV1 ≥80%
Stage 2: FEV1 50-79%
Stage 3: FEV1 30-49%
Stage 4: FEV1 <30%
Management of chronic COPD?
Non-pharmacological:
- Smoking cessation
- Nutritional support
- Flu and pneumococcal vaccinations
- Pulmonary rehabilitation
Pharmacological:
1st step:
- SABA/SAMA
2nd step:
- Add LABA and LAMA (if persistent exacerbations and no asthmatic features)
OR
- Add LABA and ICS (if persistent exacerbations and asthmatic features)
3rd step:
- 3month trial of LAMA + LABA + ICS (TRIPE THERAPY; for persistent symptoms and no asthma; if it does not work then remove ICS)
- LAMA + LABA + ICS (for any pt getting more than one severe or two moderate exacerbation in a year)
4th step:
- specialist referral
Other adjuncts: oral theophylline, mucolytic agents, antidepressants.
Management of an acute exacerbation?
Ensure airway patent.
Ensure oxygen saturations of 88–92%.
Nebulisers – salbutamol, ipratropium.
Steroids – oral prednisolone or IV hydrocortisone (if severe)
Abx (infection)
Theophylline
Monitor for type 2 respiratory failure: drowsiness, asterixis, agitation as this may indicate the need for noninvasive ventilation.
How do you distinguish asthma and COPD?
Characterised by reversible airway obstruction, episodic symptoms and response to bronchodilators.
COPD -irreversible, does not respond to bronchodilators
How do you distinguish COPD from bronchiectasis?
Bronchiectasis: Persistent productive cough, recurrent respiratory infections and abnormal bronchial dilatation on CT chest.
