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Cardio-Respiratory Block > COPD > Flashcards

COPD Flashcards

1
Q

Define COPD

A

Common progressive disorder characterized by airway obstruction (FEV1

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2
Q

What two diseases is COPD made up of?

A

Chronic Bronchitis

Emphysema

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3
Q

What is chronic bronchitis defined as?

A

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.

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4
Q

What is emphysema defined as?

A

It is defined histologically as permanent destructive enlargement of the airspaces distal to the terminal bronchiole.

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5
Q

What are the two types of COPD patients

A

Pink puffers

Blue bloaters

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6
Q

What is a pink puffer?

A

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.

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7
Q

What is a blue bloater?

A

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.

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8
Q

What are the key presenting sy,ptms of COPD (5)

A
  • Exertional dyspnoea
  • Chronic cough
  • Regular sputum production
  • Frequent winter “bronchitis”
  • Wheeze
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9
Q

How do you assess COPD severity?

A

FEV1

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10
Q

Give the number categories for COPD severity

A

> 80% - Mild
50-79% - Moderate
30-49% - Severe

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11
Q

What is the MRC breathlessness scale?

A

Quantifies the disability associated with breathlessness

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12
Q

Do MRC flashcards

A

Do MRC flashcards

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13
Q

What is the risk of in-hospital death with MRC 5?

A

22.8%

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14
Q

What is cor pulmonale?

A

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.

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15
Q

Give four signs of cor pulmonale

A
  • Peripheral oedema
  • Raised JVP
  • Hepatomegaly
  • RV gallop rhythm
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16
Q

Give 5 clinical signs of COPD in the lungs

A
  • Decreased expansion
  • Resonant or hyper-resonant percussion note
  • Quiet breath sounds
  • Hyperinflation
  • Use of accessory musles of inspiration
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17
Q

Give three systemic signs of COPD

A

Wheeze
Cyanosis
Cor pulmonale

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18
Q

Give 6 investigations for COPD

A 
FBC
CXR
ECG
ABG
LF Test
Alpha-1 antitrypsin
19
Q

What is an FBC for

A

Detecting increased PCV (anoxia stimulates RBC production)

20
Q

What four features can be seen on COPD CXR?

A
  • Hyperinflation (>6 ribs seen above diaphragm in mid-clavicular line
  • Flat hemidiaphragms
  • Large central pulmonary arteries
  • Descreased peripheral vascular markings
21
Q

What can be seen on ECG?

A
  • Right atrial and ventricular hypertrophy
22
Q

What are you looking for on ABG

A

Decreased PaO2 and potentially increased PCO2

23
Q

What will the lung function test show in COPD

A
  • Obstructive + air trapping (FEV1
24
Q

What is a COPD exacerbation?

A

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.

25
Q

What is the usual presentation of COPD exacerbation/

A

Commonly reported symptoms are worsening breathlessness, cough, increased sputum production and change in sputum colour.

26
Q

What three things must be explored in history of someone with COPD exacerbation?

A

Ask about usual/recent treatments, smoking status and MRC dyspnoea scale

27
Q

Give five differentials for COPD exacerbation

A 
Asthma
Pulmonary oedema
URT obstruction
PE
Anaphylaxis
28
Q

What is initial management of COPD exacerbation?

A

ABCDE

29
Q

What is first step after ABCDEs? (include drugs and dosages)

A

Nebulized bronchodilators

Salbultamol 5mg/4h and ipratropium bromide 500micrograms/6h

30
Q

What is after nebulized salbutamol?

A

Controlled O2 therapy if SaO2

31
Q

What are you aiming for in COPD oxygen therapy?

A

Sats of 88-92% (94-98 if no hypercapnia on ABG)

PaO2 >8kPa and a rise in PaCO2

32
Q

What is next after salbutamol and O2 therapy?

A

Steroids

33
Q

What steroid drugs are given and in what dosasge?

A

IV hydrocortisone 200mg and oral prednisolone 30mg OD (continue for 7-14 days)

34
Q

What antibiotics must be given and in what dosages?

A

If evidence of infection amoxicillin 800mg/TDS or clarithromycin

35
Q

If salbutamol, steroids and O2 fail to work, what is last ditch medication?

A

IV aminophylline

36
Q

What happens if no response to Salbutamol, steroids, O2 and IV aminophylline

A

1) Consider non-invasive positive pressure ventilation if RR >30 or pH

37
Q

If no NIV available what must be done?

A

3) Consider a respiratory stimulant drug (doxapram 1.5-4mg IV). Used only if NIV not available.

38
Q

What must be done before discharge? (4)

A

Discuss

  • Steroid reduction
  • Home O2
  • Smoking cessation
  • Pneumococcal and flue vaccination
39
Q

What are the two general treatments for COPD

A

Lifestyle (stop smoking, encourage exercise, decrease obesity, pneumococcal and influenza vaccination, pulmonary rehap/palliative care)
PRN short-acting anti-muscarinic (ipratropium) or B2 agonist

40
Q

What do you give on top of general management in COPD?

A
  • Combination of long acting B2 agonist _corticosteroids such as symbicort
41
Q

What do you give in very severe COPD on top of severe treatment and general management?

A

Tiotropium + inhaled steroid + long acting B2 agonist

- Consider steroid trial, home nebulizers, theophylline

42
Q

Give three ways to treat pulmonary hypertension

A
  • Assess the need for long term oxygen therapy
  • Treat oedema with diuretics
  • Pulmonary rehabilitation greatly valued by patients
43
Q

What does the cochrane meta-analyses say in terms of steroids and Long-acting broncho agonists

A

Cochrane meta-analyses 2007 favour steroids + LABA vs either alone. Steroids on own increase risk of pneumonia, LABA increase risk of exacerbations.

Cardio-Respiratory Block (11 decks)

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