COPD Flashcards
COPD Risk Factors
85% Smoking
(20% of smokers)
Chronic Asthma Passive Smoking Maternal Smoking Air Pollution Occupation
Alpha1-Antitrypsin deficiency
- would neutralise enzymes released by neutrophils
PiZZ = bad variant
50% of COPD <40 have this
COPD Symptoms
Breathlessness
Cough and sputum
Wheeze on exertion
Weight loss in severe disease
Peripheral oedema - cor pulmonale
Suspect COPD when: Current/former smoker Chronic cough Exertional breathless Sputum Frequent 'winter' bronchitis Wheeze/chest tightness
Symptoms of Acute Exacerbations of COPD
Increased cough, sputum, sputum purulence
Increased SOB, wheeze, unable to sleep
Increased oedema, drowsiness
Confusion, cyanosis, flapping tremor, pyrexia
COPD Signs and Common Histories
PMH of Asthma, respiratory diseases, IHD
SOB in clinic Pursed lip breathing Use of accessory muscles Cyanosis CO2 flap
Hyperexpanded chest (<3 finger breadth manubrium-larynx) Laryngeal descent Decreased cardiac dullness to percussion Decreased breath sounds Prolonged expiration with wheeze Palpable liver Cor pulmonale (increased JVP, hepatomegaly, ascites, oedema)
COPD investigations
Know current inhaler use
Occupation and smoking history
Spirometry
Full pulmonary function testing
CXR
Blood gases
FBC
ECG
Sputum
What might the results of COPD investigations be?
Spirometry:
FEV1 <80%
FEV1:FVC <70%
Reversible? Possible asthma
Full pulmonary function testing:
- looking for emphysema
- lung volumes
- CO gas transfer
CXR
- hyperinflation
- flattened diaphragm
- lucent lung fields
- bullae
Blood gases may show Type I or II respiratory failure
FBC may show secondary polycythaemia
ECG may show right axis deviation, T wave inversion, hypertrophy
COPD Differential Diagnoses
Asthma Lung cancer LV Failure Fibrosing alveolitis Bronchiectasis Rare: TB, recurrent PE
Differences between COPD and Asthma
Persistent vs Intermittent cough
Productive cough vs unproductive
Nocturnal symptoms less common in COPD
How is COPD staged?
GOLD staging
Stage 1 - Very mild
- chronic cough, sputum, SOB, discomfort
Stage 2 - Moderate - Above + reduced pulmonary function
Stage 3 - Severe - Above + unintended weight loss, frequent respiratory infections
Stage 4 - Very Severe - Above + pulmonary function <30%, life-threatening SOB
COPD Management Aims
Prevention of Progression - Smoking Cessation
Relieve SOB - inhalers
Prevention of exacerbation - inhalers, vaccines, pulmonary rehab
Management of complications - long term O2 therapy
COPD Management Ladder (Pharmacological)
Move up as FEV1 worsens
- SABA - salbutamol
> LAMA/LABA - ipratropium/salmeterol
> ICS (beclamethasone) = triple therapy
Long term O2 therapy given if PaO2 <7.3kPa
OR PaO2 7.3-8kPa if also as polycythaemia, nocturnal hypoxia, peripheral oedema, pulmonary hypertension
COPD Acute Exacerbation Treatment
Nebulised bronchodilator
- beta2/anti-muscarinic
O2
Oral/ICS, antibiotics, diuretic
- prednisolone
IV aminophylline, respiratory stimulant, non-invasive ventilation
Consider hospitalisation if tachypnoea or SaO2 <90%, hypotension
COPD Ward-based management
O2 target sat = 92%
Nebulised bronchodilators
Corticosteroids
Antibiotics
Assess for respiratory failure (blood gas)
Non-invasive ventilation if respiratory failure
Possible complications of COPD
Acute Exacerbation Pneumonia Macro-nutrient deficiency Wasting/muscle atrophy Polycythaemia Pulmonary hypertension Cor pulmonale Depression Pneumothorax
How to define chronic bronchitis?
Sputum-productive cough most days in at least 3 consecutive months, for 2 or more consecutive years
Excludes TB, bronchiectasis
