COPD Flashcards
definition of COPD
persistent cough and dyspnea with airflow limitations (FEV1/FVC ratio less than 70) due to small airway obstruction (terminal bronchioles) and parenchymal destruction (alveolar walls)
etiology?
smoking and passive smoking
exposure to air pollution or fine dust (coal miners, burning wood)
alpha 1 anti trypsin deficiency (COPD, cirrhosis)
pathophysiology?
chronic exposure to noxious stimuli -> goblet cell proliferation and mucus hypersecretion, inflammation and fibrosis, structural changes -> productive cough
symptoms and signs on physical exam?
chronic productive cough
SOB progressive on exertion -> at rest
breathing with pursed lips esp in emphysema
breathing with pursed lips
hyperresonant percussion
prolonged expiratory phase, expiratory wheeze
advanced COPD: barrel chest in emphysema, conjected neck veins
diagnosis?
spirometry: FEV1/FVC <70 after bronchodilator
high total lung capacity, functional residual capacity, residual volume
assess for resp failure if resp distress:
pulse oximetry and ABG
chest xray show hyperinflation:
barrel chest (high anteroposterior diameter)
flat diaphragm
hyperlucent lungs (decreased lung markings)
and rule out other differentials, complications
treatment?
non pharm: stop smoking, pulmonary rehabilitation, influenza and covid-10 vaccines.
pharm:
group A: LABA OR long acting muscarinic antagonists daily with SABA as rescue
group B: LABA/LAMA combination with SABA rescue
group C: LABA/LAMA/ICS with SABA rescue
complications?
respiratory failure
cor pulmonale (right heart failure)
spontaneous pnuomothorax
cardinal presentation of AECOPD? most common cause? imp investigations?
worsening dyspnea, cough, sputum production. resp failure if severe. due to resp infections. pulse oximetry, ABG, chest xray
management of AECOPD?
all patients: maintain SpO2 88-92% and start pharmacotherapy
oxygen delivery through BiPAP if not improving intubate
pharmacotherapy: SABA or SABA/SAMA with steroid IV/PO
