COPD Flashcards
what is COPD defined as and FEV
progressive disease characterised by airway obstruction with little or no reversibililty. FEV <0.7
what does COPD involve
chronic bronchitis and emphysema
what are some risk factors for COPD
age >35 yrs, smoking, chronic dyspnoea, sputum, day to day variation in FEV1
what is chronic bronchitis defined as
clinically- cough and sputum production for 3 months of 2 years. symptoms improve if stop smoking
what is emphysema defined as
histologically- enlarged air spaces distal to terminal bronchioles, destruction alveolar walls
what is the prevalence of COPD
10-20% of over 40s
what are pink puffers
increased alveolar ventilation, normal PaO2 and normal or low PaCO2.
are pink puffers breathless or cyanosed
breathless
what can pink puffers lead to
type 1 respiratory failure
what are blue bloaters
decreased alveolar ventilation, low PaO2 and high CO2
are blue bloaters breathless or cyanosed
not breathless, but are cyanosed
what can blue bloaters develop
cor pulmonale
symptoms of COPD
cough, sputum, dyspnoea, wheeze
signs of COPD
tachypnoea, use of accessory muscles, hyperinflation, decr cricosternal distance, decr expansion, resonant or hyperresonant, wheeze, cyanosis, cor pulmonale, quiet breath sounds
complications of COPD
acute exacerbations +- infection, polycythaemia (incr RBCs), respiratory failure, cor pulmonale (oedema, incr JVP), pneumothorax, carcinoma
what does the CXR show
hyperinflation, flat hemidiaphragms, large central pulmonary arteries, decr peripheral vascular markings, bullae (dilated air space in the lung parenchyma)
what can the ECG show in COPD
RVH and LVH in cor pulmonale
lung function results in COPD
obstructive + air trapping-> FEV < 80% of predicted and FEV1/FVC ratio <0.7. TLC incr, RV incr, DLCO decr in emphysema.
treatment COPD
smoking cessation, diet advice and supplements, mucolytics can help chronic productive cough, LTOT
when can LTOT be given to patients
clinically stable non smokers PaO2 <7.3kPa; if PaO2 7.3-8 and pulmonary hypertension, or polycythaemia, or peripheral oedema, or nocturnal hypoxia; terminally ill patients
what is the classification of COPD patients
stage 1 mild (FEV1<30%)
drugs used in mild
antimuscarinic or SABA eg ipratropium
drugs used in moderate
inhaled long acting antimuscarinic or LABA eg tiotropium
drugs used in severe
combination LABA + corticosteroids eg Symbicort- budesonide + formoterol or tiotropium
drugs used in pulmonary hypertension
LTOT. diuretics
when might NIV be appropriate
hypercapnic on LTOT
indications for surgery
recurrent pneumothoraces, isolated bullous disease, lung vol reduction surgery
what is steroid responsive
give 30mg prednisolone for 2 weeks. if FEV1 rises by >15% then steroid responsive
acute exacerbation of COPD is an emergency. when can it happen
in winter, triggered by bacterial/ viral infection
presentation of acute exac
incr cough, breathlessness, or wheeze. decr exercise capacity
differential diagnosis acute exac
asthma, pulmonary edema, pulmonary embolus, URT obstruction, anaphylaxis
investigations in acute exac
ABG, CXR (exclude pneumothorax and infection), FBC, U&E, CRP, ECG, sputum for culture, blood cultures if pyrexial
complications from invasive ventilation
ventilator associated pneumonias, pneumothoraces from ruptured bullae
management of acute exac
nebulized bronchodilators (salbutamol, ipratropium); controlled o2 therapy if sats <7 (start 24-28%); steroids (hydrocortisone + prednisolone); antibiotics if infection (amoxicillin); physio- sputum; if no response- aminophylline
if there is no response to drugs in acute exac
NIPPV (non invasive positive pressure ventilation). intubation and ventilation. respiratory stimulant drug eg doxapram
