COPD Flashcards
Define COPD
Common progressive disorder characterized by airway obstruction (FEV1
What two diseases is COPD made up of?
Chronic Bronchitis
Emphysema
What is chronic bronchitis defined as?
It is defined clinically as the presence of cough and excessive mucus production on most
days for at least 3 consecutive months for 2 successive years.
What is emphysema defined as?
It is defined histologically as permanent destructive enlargement of the airspaces distal to the terminal bronchiole.
What are the two types of COPD patients
Pink puffers
Blue bloaters
What is a pink puffer?
Pink puffers have increased alveolar ventilation, a near normal paO2 and a normal or low PaCO2. Breathless but no cyanosed, and may progress to type 1 respiratory failure.
What is a blue bloater?
Blue bloaters have decreased alveolar ventilation with a low paO2 and high paCO2. They are cyanosed but not breathless and may go on to develop cor pulmonale. Rely on hypoxic drive to maintain respiratory effort.
What are the key presenting sy,ptms of COPD (5)
- Exertional dyspnoea
- Chronic cough
- Regular sputum production
- Frequent winter “bronchitis”
- Wheeze
How do you assess COPD severity?
FEV1
Give the number categories for COPD severity
> 80% - Mild
50-79% - Moderate
30-49% - Severe
What is the MRC breathlessness scale?
Quantifies the disability associated with breathlessness
Do MRC flashcards
Do MRC flashcards
What is the risk of in-hospital death with MRC 5?
22.8%
What is cor pulmonale?
Right ventricular enlargement as a result of pulmonary hypertension, which in COPD comes about as a result of a ventilation-perfusion mismatch causing vasoconstriction, or loss of capillary beds due to bullous formation.
Give four signs of cor pulmonale
- Peripheral oedema
- Raised JVP
- Hepatomegaly
- RV gallop rhythm
Give 5 clinical signs of COPD in the lungs
- Decreased expansion
- Resonant or hyper-resonant percussion note
- Quiet breath sounds
- Hyperinflation
- Use of accessory musles of inspiration
Give three systemic signs of COPD
Wheeze
Cyanosis
Cor pulmonale
Give 6 investigations for COPD
FBC CXR ECG ABG LF Test Alpha-1 antitrypsin
What is an FBC for
Detecting increased PCV (anoxia stimulates RBC production)
What four features can be seen on COPD CXR?
- Hyperinflation (>6 ribs seen above diaphragm in mid-clavicular line
- Flat hemidiaphragms
- Large central pulmonary arteries
- Descreased peripheral vascular markings
What can be seen on ECG?
- Right atrial and ventricular hypertrophy
What are you looking for on ABG
Decreased PaO2 and potentially increased PCO2
What will the lung function test show in COPD
- Obstructive + air trapping (FEV1
What is a COPD exacerbation?
An exacerbation is a sustained worsening of the patient’s symptoms from their usual stable state which is beyond normal day-to-day variations, and is acute in onset.
What is the usual presentation of COPD exacerbation/
Commonly reported symptoms are worsening breathlessness, cough, increased sputum production and change in sputum colour.
What three things must be explored in history of someone with COPD exacerbation?
Ask about usual/recent treatments, smoking status and MRC dyspnoea scale
Give five differentials for COPD exacerbation
Asthma Pulmonary oedema URT obstruction PE Anaphylaxis
What is initial management of COPD exacerbation?
ABCDE
What is first step after ABCDEs? (include drugs and dosages)
Nebulized bronchodilators
Salbultamol 5mg/4h and ipratropium bromide 500micrograms/6h
What is after nebulized salbutamol?
Controlled O2 therapy if SaO2
What are you aiming for in COPD oxygen therapy?
Sats of 88-92% (94-98 if no hypercapnia on ABG)
PaO2 >8kPa and a rise in PaCO2
What is next after salbutamol and O2 therapy?
Steroids
What steroid drugs are given and in what dosasge?
IV hydrocortisone 200mg and oral prednisolone 30mg OD (continue for 7-14 days)
What antibiotics must be given and in what dosages?
If evidence of infection amoxicillin 800mg/TDS or clarithromycin
If salbutamol, steroids and O2 fail to work, what is last ditch medication?
IV aminophylline
What happens if no response to Salbutamol, steroids, O2 and IV aminophylline
1) Consider non-invasive positive pressure ventilation if RR >30 or pH
If no NIV available what must be done?
3) Consider a respiratory stimulant drug (doxapram 1.5-4mg IV). Used only if NIV not available.
What must be done before discharge? (4)
Discuss
- Steroid reduction
- Home O2
- Smoking cessation
- Pneumococcal and flue vaccination
What are the two general treatments for COPD
Lifestyle (stop smoking, encourage exercise, decrease obesity, pneumococcal and influenza vaccination, pulmonary rehap/palliative care)
PRN short-acting anti-muscarinic (ipratropium) or B2 agonist
What do you give on top of general management in COPD?
- Combination of long acting B2 agonist _corticosteroids such as symbicort
What do you give in very severe COPD on top of severe treatment and general management?
Tiotropium + inhaled steroid + long acting B2 agonist
- Consider steroid trial, home nebulizers, theophylline
Give three ways to treat pulmonary hypertension
- Assess the need for long term oxygen therapy
- Treat oedema with diuretics
- Pulmonary rehabilitation greatly valued by patients
What does the cochrane meta-analyses say in terms of steroids and Long-acting broncho agonists
Cochrane meta-analyses 2007 favour steroids + LABA vs either alone. Steroids on own increase risk of pneumonia, LABA increase risk of exacerbations.
