COPD Flashcards
What is COPD?
Long term, progressive condition
What does COPD involve?
Airway obstruction
Chronic bronchitis
Emphysema
What is chronic bronchitis?
Long term symptoms of cough and sputum
Due to inflammation of bronchi
What is emphysema?
Damage and dilation of alveolar sacs and alveoli
- decrease surface area for gas exchange
What is the presentation of COPD?
SOB
Cough
Sputum production
Wheeze
Recurrent respiratory infections
How is COPD diagnosed?
Clinical presentation
Spirometry
What would be seen on Spirometry in COPD?
Obstructive picture
-FEV1:FVC < 70%
No response to reversibility testing
How is COPD graded?
Stage 1= mild= FEV1>80% predicted
Stage 2 = moderate = FEV1 50-79% predicted
Stage 3 = severe = FEV1 30-49% predicted
Stage 4 = very severe = FEV1 < 30% predicted
What is included in the long term management of COPD?
Smoking cessation
Pneumococcal and annual flu vaccine
Pulmonary rehabilitation
What is the initial medical treatment?
Short acting beta 2 agonists (salbutamol)
Short acting muscarinic antagonists (ipratopium bromide)
What is the second step of treatment determined by?
Whether there are asthmatic or steroid response features
What would be examples of asthmatic/ steroid responsive features?
Asthma or atopy diagnosis
Variation in FEV1 of more than 400mls
Diurnal variability
Increase blood eosinophil count
What is the treatment if there are no asthma features?
Combo of LABA and LAMA
What is the treatment if there are asthma features?
LABA and ICS
What is the final step of treatment?
Combo of LABA, LAMA and ICS
When is long term oxygen therapy used?
In severe COPD with chronic hypoxia, polycycaemia, cyanosis or cor pulmonale
When is LTOT contraindicated?
Smoking
What is cor pulmonale?
Right sided heart failure
What is cor pulmonale caused by?
Respiratory diseases:
-COPD
- PE
- interstitial lung disease
- cystic fibrosis
- primary pulmonary hypertension
What is the pathophysiology of cor pulmonale?
Increase pressure and resistance in pulmonary arteries -> limited right ventricle pumping blood
=> back pressure into right atrium, vena cava and systemic venous system
What are the symptoms of cor pulmonale?
Asymptomatic
SOB
Peripheral oedema
Breathless on exertion
Syncope
Chest pain
What are the signs of cor pulmonale?
Hypoxia
Cyanosis
Increased JVP
Peripheral oedema
Parasternal heave
Loud second heart sound
Pan systolic in tricuspid regurgitation heart murmur
Hepatomegaly
What is the management of cor pulmonale?
Treat symptoms
Treat underlying cause
What are acute exacerbation of COPD triggered by?
Bacterial and viral infection
What is seen on arterial blood gas in an exacerbation?
Respiratory acidosis
Decreased pH
Decreased pO2
Increased pCO2
Increased bicarbonate
What is the management of exacerbations?
First line:
-regular inhalers or nebulisers
-steroids
-antibiotics
Respiratory physiotherapy to clear sputum
In severe cases:
-IV aminophylline
-non-invasive ventilation
-intubation and ventilation
