COPD Flashcards
What is COPD?
Chronic obstructive pulmonary disease is a long term, progressive condition involving airway obstruction, chronic bronchitis, and emphysema
What is chronic bronchitis?
Long term symptoms of a cough and sputum production due to inflammation in the bronchi
What is emphysema?
Damage and dilation of the alveolar sacs, decreasing the surface area for gas exchange
What are the causes of COPD?
SMOKING
Environmental causes:
- Cadmium (smelting)
- Coal
- Cotton
- Cement
- Grain
What are the features of COPD?
Cough - productive
Dyspnoea
Wheeze
Recurrent respiratory infections
What symptoms does COPD NOT cause?
Clubbing
Haemoptysis
Chest pain
What is the MRC dyspnoea scale?
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
How is the severity of COPD graded?
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
How is COPD diagnosed?
Diagnosis based on clinical presentation and spirometry results
What will be seen on spirometry in a patient with COPD?
Obstructive picture
- FEV1:FVC ratio of less than 70%
Little to no response to reversibility testing with beta-2 agonists
What other investigations may be helpful in diagnosis of COPD?
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
What is seen on CXR in COPD?
Hyperinflation
Bullae - air filled spaces in the lungs
Flat hemidiaphragm
What vaccines should patients with COPD have?
Pneumococcal
Annual flu vaccine
Annual covid vaccine
What is the initial management of COPD?
SABA
SAMA e.g ipratropium bromide
What criteria determine asthma/steroid responsive features?
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%
What is the second line treatment when there is asthmatic or steroid-responsive features?
A combination of:
- LABA
- ICS
What is the second line treatment where there are asthmatic/steroid responsive features present?
Combination of:
- LABA
- LAMA
What is the third line management of COPD?
Combination of:
- LABA
- LAMA
- ICS
What antibiotic is used in some patients as prophylactic therapy?
Azithromycin
What are the criteria for azithromycin antibiotic therapy?
Non-smoker
Optimised standard treatments
Continues exacerbations
CT thorax and sputum culture
LFTs
ECG to exclude QT prolongation
Which patients may receive long term oxygen therapy?
Severe COPD with chronic hypoxia (<92%)
Polycythaemia
Cyanosis
Cor pulmonale
What is cor pulmonale?
Right-sided heart failure due to respiratory disease
What are the causes of cor pulmonale?
COPD - most common
PE
Interstitial lung disease
CF
Primary pulmonary hypertension
What are the symptoms of cor pulmonale?
Dyspnoea
Peripheral oedema
Breathlessness on exertion
Syncope
Chest pain
What are the signs of cor pulmonale on examination?
Hypoxia
Cyanosis
Raised JVP
Peripheral oedema
Parasternal heave
Loud second heart sound
Murmurs
Hepatomegaly
What may be seen on a blood gas in acute COPD exacerbation?
Respiratory acidosis
- Low pH
- Low pO2
- Raised pCO2
- Raised bicarbonate - chronic retention
What other investigations are useful in an acute exacerbation of COPD?
CXR
ECG
FBC
U&E
Sputum culture
Blood cultures
What are the target sats for a COPD patient who are at risk of retaining CO2?
88-92%
What are the normal target sats for a patient with COPD?
94-98%
What is the first line medical treatment of an acute exacerbation of COPD?
Regular inhalers and nebulisers
Steroids (prednisolone 30mg OD for 7 days)
Antibiotics
When is NIV considered in acute exacerbation of COPD?
Persistent respiratory acidosis despite maximal medical treatment
When are phosphodiesterase-4 inhibitors recommended for COPD?
If:
- Disease is severe (FEV1 after a bronchodilator of less than 50% of predicted normal)
- Patient has had 2 or more exacerbations in previous 12 months despite triple inhaled therapy
