COPD Flashcards
Maintenance Mx of COPD
Confirm Dx (exclude asthma, and assess spirometry. ID and avoid RF Preventing progression of the condition, relieve symptoms, and tx and reduce exacerbations. 1 - Stop smoking - Physio - Vaccines to prevent Medication 2- SABA or SAMA - ventolin 3- LABA - salmeterol, serevent or LAMA - Trotropium, spiriva 4- Combination LABA and LAMA - 5 - Combination of ICS, LABA and LAMA 6 - Oxygen RV in 4-6wk
Acute Mx of COPD
SABA Ipratropium Oral corticosteroids - less then 14 days Antibiotics- Amoxycillin or doxycycline for 5 days. (if increase dyspnoea,sputum volume, and sputum purulence. Stop smoking Chest physio weaning of prednisolone
Features of COPD
Cardial - Dyspnea, chronic cough, sputum
RF - over 40yr, Hx of smoking, occupation, pollution
Trigger
O/E
GI - tripod position, accessory muscle use, pursed lip breathing, cyanosis, work of breathing, In drawing, CO2 retention (confusion)
Vital - Tachycardia, tachypnoea, Low O2 stat, BMI, BSL, pulse reg, reg (bounding if CO2 retention), BP
Hand - Asterixix (CO2 retention), nitcotine staining, axillary lymph nodes, warm (Co2 retention)
Face - eyes - sub conjunctive haemorrhage, mouth- peripheral and central cyanosis and signs of infection. thick leathery wrinkled skin.
Neck - Raised JVP, tracheal tug, cervical lymph nodes
Resp - I - Barrel chest appearance, drawing in of intercostals, chest wall abdomelities
P - increased chest expansion, Hoover’s sign (paradoxical retraction of lower interspaces during inspiration, Apex may be absent.
P - hyperinflation, signs of changes in resonance, vocal fremus if pneumonia or pleural effusion sucepted
A - Wheezes, basal crackles - early inspiration of medium coarseness.
Chest - apex beat displaced, P2 heart sound present, Parasternal heave
Abdo - I signs of cor pulmonary
P - hepatomegaly
Legs - warm and well purfused, cap refill, oedema
Cx og COPD
Secondary infection Pneumothorax Bronchiectasis Cor pulmonale End stage lung Lung cancer
Ix for COPD
Confirm diagnosis - Spirometry = Reduced peak expiratory flow FEV1 less then 80% of predicted Reduced FEV1:FVC ratio of 70% BMI CXR FBC - HB, WCC U and E - Salt and water depletion ECG Resp FT Blood gases - Respiratory acidosis Alpha antitrypsin if early onset or little smoking Hx. CT scan if abnormalities not consistent with obstruction airway
Severity of COPD
Mild COPD - FEV1 60-80%
Moderate COPD FEV1 40-60% of predicted
Severe COPD FEV1 less then 40%
Organisms involved in a acute exacerbation of COPD
Viral
S. pneumonia
H. influenza
Moraxella catarrhalis
Causes for the different types of emphysema
Centrilobular is proximal part of the acinus and is associated with smoking
Paracinar is associated with Alpha 1 antitrypsin deficiency
panacinar
