COPD Flashcards
What is COPD
A disease characterised by airflow obstruction which is usually progressive and irreversible. It encompasses emphysema and chronic bronchitis
How is obstruction defined diagnostically in respiratory disease
FEV1 less than 80% and FEV1/FVC ratio less than 0.7
How do you diagnose bronchitis
It is a symptomatic diagnosis - sputum production for >3 months of the year, for >1 year
How do you diagnose emphysema
It is a histological diagnosis, dilatation of the air spaces distal to the terminal bronchioles
What are the causes of COPD
Smoking Atmospheric pollution (most common worldwide) - may play a role Alpha-1 Antitrypsin deficiency - a rare cause of emphysema
What might a patient with COPD complain of
SOB
Cough with sputum
Wheeze
Does COPD cause clubbing
No
What signs might you see on a COPD patient
Use of accessory muscles Pursed lip breathing Asterixis - if CO2 retention Reduced cricosternal distance - hyperexpansion Reduced chest expansion Reduced breath sounds
*May be coarse crackles if infective exacerbation
Why might you do an ECG on a COPD patient
To look for signs of right ventricular hypertrophy
What oxygen saturations are you aiming for in an acutely ill COPD patient
88-92%
How would you give oxygen in the acute setting to a COPD patient
Use either a 24% or 28% venturi mask and oxygen at 4L/min
What is the criteria for long term oxygen therapy for a COPD patient
If PaO2 less than 7.3 and patient is stable (more than 5 weeks since last exacerbation)
Non-smoker (long term)
What important investigations should be done to investigate COPD?
Bedside- culture MCS
ABG
Imaging: CXR- hyperexpansion, bullae, ruling out malignancy, infective exacerbation or other lung disease
Pulmonary function tests
What is the medical management for chronic COPD?
3 steps:
- Relievers- short acting beta agonists e.g Atrovent
- LABA e.g. Spiriva/long acting muscarinic antagonist
- Combination with steroids e.g. Seretide
Why are steroids avoided where possible in Copd?
Expensive
Increased risk pneumonia
