COPD Flashcards
Two common types of COPD
chronic bronchitis
emphysema
emphysema
hyperinflation
chronic bronchitis
airflow obstruction
not fully reversible
What is COPD?
airflow obstruction, progressive disease that is not fully reversible
What happens to the airways in COPD?
mucus build up
airway muscles tighten
airway lining swells (inflammation)
Main three symptoms of COPD
Breathlessness
Cough
Recurrent chest infections
Developing symptoms of COPD
Weight loss
loss of muscle mass
cardiac disease
depression, anxiety
Things to look for in order to diagnose COPD
age 35 or more
current or former smoker
Chronic cough
exertional SOB
sputum production
Frequent ‘winter’ bronchitis
Wheeze/ chest tightness
On examination, COPD symptoms
reduced chest expansion
prolonged expiration/ wheeze
hyper inflated chest
respiratory failure
respiratory failure in COPD symptoms
tachypnoea
cyanosis
use of accessory muscles
pursed lip breathing
reduced breath sounds
peripheral oedema
Tachypnoea
abnormally fast breathing
Cyanosis
blue colour to the skin and mucus membranes
Peripheral Oedema
Fluid accumulation in the peripheral vascular system
usually in the lower limbs
Spirometry
Will confirm diagnosis and assess severity
COPD severity
FEV1/FVC is less than…
0.7
post-bronchodilator
FEV1 in COPD
80%
mild
FEV1 in COPD
50-79%
moderate
FEV1 in COPD
30-49%
severe
FEV1 in COPD
less than 30%
very severe
COPD baseline tests
CXR
ECG
Spirometry (recorded absolute and % predicted value)
Full blood count (looking for anaemia etc)
BMI
Blood gases
COPD intervention
non-pharmalogical
Smoking cessation
Long term oxygen therapy
Pulmonary Rehabilitation
Vaccines
physiological support
Short acting bronchodilators
SABA (eg salbutamol)
SAMA (eg ipratropium)
Long acting bronchodilators
LAMA (long acting muscarinic agents) (eg umeclidinium, tioptropium)
LABA (long acting Beta 2 agonist) (eg salmeterol)
High dose inhaled corticosteroids (ICS) and LABA
relvar
fostair MDI
COPD - long term oxygen is needed is PaO2 is less than
7.3 kPa
Polycythaemia
abnormally high haemoglobin in the blood
Exacerbated COPD management
Short acting bronchodilators (salbutamol etc)
Steroids (prednisone 40mg pre day 5-7days)
Antibiotics (if evidence of infection)
Consider hospital admission if unwell (tachypnoea, low oxygen saturation of 90-92%, hypotension)
Causes of COPD
chronic asthma
passive smoking
maternal smoking
air pollution
occupation
Stethoscope reading for COPD
reduced breath sounds
Significant bronchodilator/steroid response suggest asthma/asthmatic component. No significant response would suggest
COPD
Useful Investigations: Chest X-Ray in COPD would show you
hyper inflated lung fields
flattened diaphragms
Lucent lung fields
bullae (blister/fluid build up)
All symptoms of COPD
Cough increased sputum sputum purulence SOB Wheeze drowsiness unable to sleep oedema
Other COPD symptoms
Confusion cyanosis breathless flapping tremor pyrexial
Pyrexial
fever
What to do?
Chest radiograph
blood gases
FBC
Sputum culture
