COPD Flashcards
What is the general management advice for COPD
Smoking cessation
annual influenza vaccine
one off penumococcal vaccine
What is the pharmacological management for COPD
- Bronchodilator therapy - SABA e.g salbutamol
If patient is still breathless then next step is determined by FEV %
FEV >50%
- LABA e.g. salmeterol or LAMA e.g. tiotropium
FEV <50%
- LABA + ICS
or
- LAMA
With patients with frequent exacerbations and FEV > 50%
if taking LABA –> LABA + ICS
or LAMA + LABA if ICS not tolerated
Otherwise give LAMA + LABA + ICS
When are mucolytics considered
patients with a chronic productive cough and continue if symptoms improve
What is COPD
It is a progressive obstructive lung disease which encompasses the conditions empysema and chronic bronchitis.
It causes narrowing of the airways in the lungs causing shortness of breath, cough and sputum production
What is the difference between COPD and asthma in lung function tests
Asthma patients show reversibility after a bronchodilator COPD patients do not
How is COPD investigated
CXR - hyper inflation
Spirometry with reversiblity - will show obstructive pattern FEV/FVC <70%
mildly improved <15% with bronchodilator
ECG - may show right ventricular hypertrophy due to cor pulmonale
If non-smoker do blood test for alpha-1-antitrypsin
How does COPD present
Chronic SOB
Productive cough
Wheeze
Cyanosis
Use of accessory muscles and purse lip breathing
Tachypneoa
Hyperinflation of chest –> hyper resonance and barrel chest
Reduced expansion
Quiet breath sounds
May have peripheral oedema - cor pulmonale
What are the features that may be seen on CXR
Flattened hemidiaphragms
Small heart
possible bullous changes
on a lateral radiograph - a barrel chest with a widened anterior-posterior diameter may be seen
When is LTOT offered
in very severe cases patients with pO2 of <7.3kPa or patients with pO2 of 7.3 - 8kPa AND one of the following - secondary polycythaemia - nocturnal hypoxemia - peripheral oedema - pulonary hypertension
Which treatments improve survival in stable COPD patients
Smoking cessation
LTOT
Surgical reduction of the lungs
How is cor pulmonale managed
Use a loop diuretic for oedema and consider LTOT
What are the signs and symptoms of cor pulmonale
Peripheral oedema
Raised JVP
systolic parasternal heave
loud P2
What are the target sats for a COPD patient
88-92%
What happens to a COPD patient if they are given oxygen to increase their sats and they already have sats of 88-92%?
Knocks off hypoxic drive
pH of the CSF is lower due to CO2 retention and this drives respiratory effort. If more oxygen is given the patient goes into resp acidosis and retains even more co2
Which organisms commonly causes COPD exacerbations
Haemophilus influenzae
Strep pneumoniae
Moraxella Caterrhalis
When a COPD is hypoxic what should be done
Give o2 15L non-rebreathe
When is NIV used
Respiratory acidosis of 7.25-7.35
Type 2 respiratory failure secondary to chest wall deformity, neuromusclar disease or sleep apneoa
Cardiogenic pulmonary oedema unresponsive to CPAP
weaning from tracheal intubation
How may acute exacerbation of COPD present
Increased SOB and decreased exercise tolerance
Increased cough with change in colour of sputum
Increase in wheeze and chest tightness
Malaise
Fever
Confusion
Night sweats
May become hypoxic and retain more CO2 due to reduction in lung function
What are the differentials for acute exacerbation of COPD
Pneumonia Pneumothorax Left ventricular failure/pulmonary oedema PE Pleural effusion Lung cancer/upper airway obstruction bronchiectasis
How would you investigate an acute exacerbation of COPD
Xray - rule out pneumonia, pneumothorax, effusions and oedema
Bloods
- FBC - raised WCC
- CRP - may be raised
- U+Es and LFTs - check no SIRS or Sepsis
- D-dimer to rule out PE
Sputum culture
Blood culture
