COPD Flashcards

Obstructive Lung Diseases

1
Q

What is COPD?

A

COPD is a long-term, progressive condition of the lungs that involves airway obstruction, chronic bronchitis and emphysema.

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2
Q

What is Chronic bronchitis and what symptoms does it result in?

What is emphysema?

A

Chronic bronchitis is the inflammation of the bronchi that causes long-term cough and sputum production.

Emphysema is the damage and enlargement/dilation of the alveolar sacs and alveoli that causes a reduction in the surface area for gas exchange.

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3
Q

What are the typical presentations of COPD?

A
  • Usually occurs in long-term smokers
  • Cough
  • Wheeze
  • Sputum production
  • Shortness of Breath
  • Recurrent infections, particularly during the winters
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4
Q

Which signs or symptoms are NOT seen in COPD? What might they suggest instead?

A
  • Finger clubbing
  • hemoptysis
  • chest pain

These symptoms may suggest lung cancer, fibrosis or heart failure instead.

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5
Q

Describe what each grade (1-5) in the MRC Dyspnoea scale indicates.

A

1- breathless upon strenuous exercise
2-breathless while walking up a hill
3- breathless that slows walking on a flat surface
4- breathlessness that stops them from walking more than 100 meters
5- cannot leave the house due to breathlessness

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6
Q

How is COPD Diagnosed?

A

Combination of clinical presentations and history along with spirometry (FEV1: FVC ratio less than 70%).

If reversible obstruction is noted when treated with salbutamol (short-acting beta agonist), it is more likely to be Asthma.

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7
Q

What are the four stages of severity that can be graded using the FEV1 values?

A

Stage 1 (mild)- above 80%
Stage 2 (moderate)- 50-79%
Stage 3 (severe)- 30-49%
Stage 4 (very severe)- less than 30%

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8
Q

What other investigations can be done to rule out other conditions?

A
  • FBC- to detect chronic hypoxia, anaemia and infection
  • Chest x-rays- to rule out lung cancers
  • CT thorax- to rule out cancer, fibrosis or bronchiectasis
  • BMI- sudden weight loss may suggest a severe condition
  • ECG and echo for heart failure or cor pulmonale
  • Sputum culture for chronic infections such as pseudomonas
  • TLCO- tests the diffusion of inhaled gases in the blood (reduced in COPD)
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9
Q

What are the long-term management strategies for COPD?

A
  • smoking cessation
  • pulmonary rehab
  • pneumococcal and annual flu vaccines
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10
Q

What is the initial medical treatment for COPD?

A
  • short acting beta agonists (salbutamol)
  • short acting muscurinic antagonists (ipratopium bromide)
  • SABA+ SAMA
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11
Q

What is next step of treatment with and without asthmatic features?

A

Without:
- long-acting beta-agonist
- long-acting muscarinic antagonist
- LABA+ LAMA

With:
- long-acting beta-agonist
- Inhaled corticosteroids
- LABA+ ICS

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12
Q

What are some other treatment options in severe cases of COPD? What would you use to treat exacerbations?

A
  • Oral mucolytic therapy (carbocysteine)
  • prophylactic antibiotics
  • oral theophylline (bronchodilator)
  • Lung volume reduction therapy
  • long-term Oxygen therapy
  • oral corticosteroids
  • nebulizers (salbutamol, etc)

For Exacerbations:
- Oral corticosteroids (prednisolone)
- Oral ABs (doxycycline)

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13
Q

What needs to be monitored in patients that are taking azithromycin?

A
  • liver function and ECG changes before and during the treatment
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14
Q

What is cor pulmonale? What is the physiology behind it?

A

Refers to right-sided heart failure secondary to a respiratory disease.

The increased pressure and resistance in the pulmonary arteries (pulmonary hypertension) limits the right ventricle pumping blood into the pulmonary arteries. This causes back-pressure into the right atrium, vena cava and systemic venous system.

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15
Q

Often patients with early cor pulmonale are asymptomatic, what are the symptoms of cor pulmonale?

A
  • shortness of breath on exertion
  • syncope
  • peripheral odema
  • chest pain
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16
Q

What are the clinical signs of cor pulmonale?

A
  • hypoxia
  • cyanosis
  • raised JVP (due to a back-log of blood in the jugular veins)
  • peripheral oedema
  • loud second heart sound
  • murmurs (pan-systolic in tricuspid regurgitation)
  • parasternal heave
  • hepatomegaly (due to back pressure in the hepatic vein)
17
Q

What does the management of cor pulmonale involve? What is its prognosis like?

A
  • involves managing the symptoms- diuretics for peripheral oedema, long-term oxygen therapy
  • prognosis is often poor unless there is a reversible underlying cause
18
Q

What does an acute exacerbation of COPD look like?

A

rapidly worsening symptoms of COPD such as cough, wheezing, sputum production, and shortness of breath which usually are triggered by a viral or bacterial infection.

  • also presents with respiratory acidosis (low pH, low O2, raised pCO2, raised bicarb)
19
Q

What other investigations are done during an acute exacerbation of COPD?

A
  • Chest X-rays- to look for pneumonia
  • ECG- to check for any arrhythmias or heart strain
  • Full blood count to look for infection (raised white blood cells)
  • U&E to check electrolytes, which can be affected by infections and medications
  • Sputum culture
  • Blood cultures in patients with signs of sepsis (e.g., fever)
20
Q

What is the target O2 for COPD patients who are retaining CO2? Which masks are used to deliver oxygen of specific concentration?

A

88-92%

Venturi masks

21
Q

What is the first-line management of acute exacerbation of COPD?

A
  • nebulizers with salbutamol
  • antibiotics if infection found
  • steroids
  • resp physiotherapy can be used to clear sputum
22
Q

What additional treatment options are used in severe cases of acute exacerbations of COPD?

A
  • IV aminophylline
  • Non-invasive ventilation (NIV)
  • Intubation and ventilation with admission to intensive care
23
Q

How do you manage a COPD exacerbation?

A

1) Oxygen- should aim for between 88-92%
2) High-dose SABA- nebulized
3) High-dose corticosteroids
4) Antibiotics (depends on whether the patient presents with infection)
5) Reassess after an hour

24
Q

What is the difference between Type I and Type II respiratory failure?

A

Type I:
- hypoxaemic failure
- PaO2 of less than 8kPa. It indicates a serious underlying pathology with the lungs such as infection, oedema or a shunt.

Type II:
- ventilatory failure
- PaCO2 is more than 7kPa. Reduced ventilatory effort can be a result of gas trapping, such as in COPD and severe asthma, due to chest wall deformities, muscle weakness or central causes of respiratory depression

25
Q

What are the clinical signs of hypercapnia?

A
  • altered mental state- confusion
  • headaches
  • vasodilation in the brain- can lead to a coma
  • pupillary dilation
  • flushed skin
  • bounding pulse
  • flapping tremor