COPD Flashcards
Definition
Irreversible progressive inflammatory airway obstruction disease. Usually caused by tobacco smoke exposure.
Aetiology
Tobacco
Occupational eg dust, gas, vapour, silica, coal.
Atmospheric pollution.
Alpha1 antiT deficiency.
Chronic bronchitis- obstruction small airways dye to mucous hypersecretion, productive cough over 3 months for more than 2 successive years. Reduced recoil and air trapping.
Emphysema- loss elastin in alveoli, destruction of parenchyma, enlargement of air spaces, bronchioles narrowing.
Differentials
HF Asthma TB or other infection Bronchiectasis CF Neoplasm PE Obliterative bronchiolitis Obstructive sleep apnoea Hypothyroid Neuromuscular disease
Management
Oral steroid trial
Avoid tobacco and pollutants
Vaccines (flu and pneumococcal) or chronic AB.
Rehab, nutrition etc
Weight loss
SABA or anticholinergic, then inhaled CS, then oral CS.
Supplemental O, sometimes LTOT if pO2 consistently under 7.3 or 8 with cor pulmonale.
Mucolytics eg carbocysteine
Methyxanthines eg theophylline inhibit Pdiesterase= increase cAMP, but risk SVT, nausea and seizure.
Lung volume reduction surgery rare.
Transplant
AVOID high dose oxygen. Target pO2 88-92%.
Complications
Acute exacerbation eg ABs, infection. Recurrent infection, pneumonia Polycythaemia Respiratory failure T2 Cor pulmonale due to pulmonary vasoconstriction and sm thickening- ankle swelling etc. Pneumothorax Lung CA
Symptoms
Cough usually worse in morning, chronic, productive
Sputum
Dyspnoea progressive
Wheeze with hyperventilation
Tachypnoea to compensate for hypoxia
NOT diurnal variation and NOT night waking
Signs
Tachypnoea Accessory muscles, pursed lips Hyperinflation Increased cricosternal distance Decreased expansion Resonance Quiet breath sounds over bullae Wheeze Cyanosis Cor pulmonale Flapping tremor
Diagnosis
CXR hyperinflation, flat hemidiaphragms, bullae, large central pulmonary arteries.
ECG RVH if cor pulmonale.
Function- obstructive pattern. FEV1/FVC under 70%, FEV1 under 80%.
ABG- hypoxia and hypercapnia maybe.
A1 antiT blood test in young patient.
High resolution CT.
Pathological changes
Increase size mucous glands Increase number goblet cells Decreases cilia function Elastin breakdown Reduced surface area Vascular change causes pulmonary HTN
MRC dyspnoea score
1-SOB on strenuous exercise
2-SOB when hurry or incline
3-walk slower on level ground due to SOB, or has to stop
4-stops after 100m walking or a few mins on level ground
5-SOB on basic tasks
Anticholinergic ADRs
-Local- Dry mouth and cough Sore throat Pharyngitis URTI Bitter taste Nausea Glaucoma acute -Systemic- SVT, AF Urinary difficulty and retention Constipation
Steroid ADRs
CAB TO MI GP
Cataracts Adrenal insufficiency Bruising Thin skin OP Mental disturbance Increase weight GI Proximal myopathy
Explanation
- Chronic obstructive pulmonary disease is a progressive disorder where the airways in the lungs become damaged. It can either be because of too much mucous secretion or a loss of stretchiness of the air sacs in the lungs. Both of these things make it difficult to breathe in enough air. The damage is usually due to smoking but not always.
- generally symptoms get worse over months or years and you are able to less activity. In the LT this can put strain on your heart and can lead to HF, but treatment aim to avoid this. Can get sudden episodes of worsened SOB eg if you have an infection.
- stop smoking. Lose weight. Good nutrition. Controlled exercise.
- inhalers for if you feel it getting bad. Daily steroids. Home oxygen. ABs for infections. Occasionally surgery. Other drugs as well for the airways.
