COPD Flashcards
What are the 3 most significant features of pink puffers?
Increased alveolar ventilation
Normal O2
Normal/low CO2
Which COPD condition are ‘pink puffers’ associated with?
Emphysema
What kind of respiratory failure can pink puffers experience?
Type 1
Which COPD condition are blue bloaters associated with?
Chronic bronchitis
What are the 3 most signif features of blue bloaters?
Decreased alveolar ventilation
Decreased PaO2
Increased CO2
What is a major complication of blue bloaters (but not pink puffers)?
Cor Pulmonale
Describe the process by which Cor Pulmonale can develop in COPD.
COPD ➡️ pulmonary hypertension (due to: capillary bed damage and hypoxia causing local vasoconstriction as a protection mechanism to divert blood to well ventilated areas) ➡️ backlog of blood ➡️ right heart failure
With which COPD patients do you need to be careful about giving oxygen to? Why?
Blue bloaters - their resp centres are insensitive to CO2 and so rely on hypoxic drive to maintain resp effort
What are the 4 main symptoms of COPD?
Cough
Sputum
Dyspnoea
Wheeze
What is polycythemia and how is it relevant in COPD?
Incr RBC production in response to hypoxia. Can give a red face. NB - only seen in ‘blue bloaters’.
Why are blue bloaters blue?
Cyanosis and polycythemia
What are the two COPD treatments that can improve prognosis?
Smoking cessation
02 therapy
Why is pneumothorax a complication of COPD?
Bullae (air pockets in lungs; emphysema) can rupture
Why is lung carcinoma a potential COPD complication?
?? Chronic inflammation??
What might a COPD CXR show? (5 things)
Hyperinflation (>6 anterior ribs above diaphragm in mid clavicular line) Flat hemidiaphragms Large central pulmonary arteries Bullae Decreased peripheral lung markings
What does FEV1 need to be to diagnose COPD?
<80% predicted
What does FEV1/FVC need to be to diagnose COPD?
<0.7: ie an obstructive picture
What will total lung capacity and residual volume be in COPD?
Increased TLC and RV
What will the gas transfer efficient be in COPD (emphysema)?
DLCO = Decreased
What might a COPD ECG show? And in what circumstance?
Right atrial and ventricular hypertrophy in Cor Pulmonale.
How do you treat an acute exacerbation of COPD?
Incr bronchodilator use
30mg oral prednisolone for 7-14 days
How do you classify COPD severity?
Mild: FEV1 > 80% predicted
Moderate: FEV1 = 50-79% predicted
Severe: FEV1 = 30-49% predicted
Very severe: FEV1 < 30% predicted
What is the non pharmacological treatment for all COPD (regardless of severity)?
Smoking cessation Incr exercise Treat poor nutrition and obesity Influenza and pneumococcal vaccination Pulmonary rehabilitation
What is the pharmacological treatment for all COPD (regardless of severity)
PRN - SAMA (ipratropium) SABA (salbutamol)
How would you treat mild/moderate COPD?
LAMA (tiatropium) or LABA (salmeterol)
How would you treat severe COPD?
LABA + corticosteroid: eg. SYMBICORT (formeterol + budesonide)
OR
LAMA (tiotropium)
How would you treat COPD that remained symptomatic despite severe treatment options?
LAMA + inhaled steroid + LABA
When should you consider oxygen therapy in COPD? Consider:
1) Clinically stable non-smokers
2) Those with plum hypertension, polycythaemia, peripheral oedema, nocturnal hypoxia
3) When else might you prescribe oxygen?
1) When O2
When can COPD not be caused by smoking?
Alpha1-antitrypsin deficiency
Describe the process by which alpha1-antitrypsin deficiency can cause COPD?
Finish
If you are worried about hypoxic respiratory drive in COPD patients, what O2 sats should you aim for?
88-92%
What is the indication for hypoxic drive in COPD patients?
Chronic hypercapnia
