COPD Flashcards
What is the gold standard test for diagnosing COPD?
Spirometry
What is pattern in obstructive lung disease?
Reduced FVC, reduced FEV1:FVC ratio, reduced peak flow
Why causes FEV1 to be lowered?
Airways are narrowed so air can’t travel out of the lungs as quickly.
What is the pattern of restrictive lung disease?
Reduced FVC, Reduced FEV1, Normal FEV1:FVC ratio, Normal PEFR
What is pulmonary fibrosis?
It is an interstitial lung disease which causes scaring (fibrosis) and increased amount of tissue in the interstitium.
What pattern of results would be seen in IPF?
reduced FEV1, reduced FVC, increased FEV1/FVC, increased TLCO
What are the clinical features of pulmonary hypertension?
Hypoxia, hypercapnia, salt and water retention (cor pulmonale), elevated JVP and peripheral oedema.
What is pack year?
A way of quantifying an individuals’ exposure to tobacco over timeo It is calculated by multiplying the number of packs (20 in a pack) of cigarettes smoked per day by the number of years smoked.
What are the hallmark symptoms of COPD?
shortness of breath, chronic cough, sputum production
What is COPD?
COPD is a disease characterised by persistent airflow limitation that is usually progressive, and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. The airflow obstruction is not usually reversible. It encompasses chronic bronchitis and emphysema.
What is chronic bronchitis
cough and sputum on most days for at least 3 months, in each of 2 consecutive years
what is emphysema?
abnormal permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis
What are signs of COPD?
pursed lip breathing, hyper-inflated barrel chest, reduced breath sounds, wheeze, intercostal indrawing, central cyanosis, reduced cricosternal distance, cardiac apex not palpable, weight loss, skeletal muscle dysfunction, increased residual volume
What is the most significant risk factor for developing COPD?
Cigarette Smoking
What host factors increase risk of COPD development?
alpha-1 antiprotenase deficiency, airways hyper-reactivity
What histological changes are seen in COPD?
goblet cell hyperplasia, airway narrowing and alveolar destruction
How is breathlessness severity quantified?
modified MRC dyspnoea scale
What causes pitting oedema?
failure of salt and water excretion by the hypoxic hypercapnic kidney
What is a pink puffer?
typically thin and breathless, and maintain a normal PaCO2 until the late stage of disease
What is a blue bloater?
a patient who develops (or tolerate) hypercapnia earlier and may develop oedema and secondary polycythaemia.
How is suspected COPD investigated?
CXR, blood count (anaemia/polycythaemia), spirometry
When is a COPD diagnosis established?
the post-bronchodilator FEV1/FVC is less than 70%.
How is severity of COPD staged?
Using GOLD staging. in relation to the post-bronchodilator FEV1. The higher the stage, the worse the FEV1.
How is COPD managed?
Cessation of smoking, bronchodilators, corticosteroids, pulmonary rehab, annual influenza vaccine, pneumococcal vaccination
What is first step for symptom relief in COPD?
SABA or SAMA
What is used in moderate to severe disease?
LABA or LAMA
When are ICS indicated?
recommended in patients with severe disease (FEV1 < 50%) who report two or more exacerbations requiring antibiotics or oral steroids per year.
What medications is indicated for a patient who is still breathless with FEV1/FVC > 50
LABA or LAMA
What medications is indicated for a patient who has frequent exacerbations with FEV1/FVC < 50
LABA + ICS or LAMA
What is the 3rd step treatment?
LAMA or LABA+ICS
What characterises an acute exacerbation of COPD?
increase in symptoms and deterioration in lung function and health status
What triggers an acute exacerbation?
bacteria, viruses or a change in air quality.
Which bacteria usually causes an exacerbation?
H Influenzae
How is an acute exacerbation managed at home?
increased bronchodilator therapy, a short course of oral corticosteroids and, if appropriate, antibiotics.
When must a patient be referred?
The presence of cyanosis, peripheral oedema or an alteration in consciousness
What are symptoms of an acute exacerbation of COPD?
Increased breathlessness, increased cough, increased sputum, sputum purulence, ankle swelling
What investigations are carried out in an acute exacerbation of COPD?
FBC, U&Es, CRP, ABGs, sputum culture, CXR, ECG
How much oxygen should be given in an acute exacerbation of COPD?
24%-28%
What oxygen sats are aimed for in patient’s with COPD?
88-92%
What PaO2 is aimed for?
> 8 kPa
How is an acute exacerbation of COPD managed (8)?
1) Nebulised salbutamol 5mg/4hr and ipratropium 500mcg/6hr
2) 24-28% O2 via venturi mask
3) steroids - IV hydrocortisone 100mg and prednisolone 30mg OD (7 days)
4) Antibiotics - if evidence of infection
5) Physio - aid sputum expectoration
6) IV aminophtlline
7) NIPPV (BIPAP) or doxapram IC
8) Intubate and ventilate
What are complications of COPD?
Peripheral oedema, cor pulmonale, right sided heart failure
What is p pulmonale a sign of?
right atrial enlargement
What are side effects of beta-2-agonists?
tachycardia, arrhythmias, tremor, hypokalaemia
What are side effects of anti-muscarinics?
dry mouth, nausea, headache
How do the xanthines (aminophylline) work?
Xanthines inhibit PDE and increase levels of cAMP. cAMP (causes bronchodilation) is normally broken down by PDE into AMP.
How does magnesium work?
Bronchodilation effect by blocking Ca2+ channels
When is long term oxygen therapy indicated?
PaO2 <8.0 kPa on air and evidence of cor pulmonale
or
PaO2 <7.3 kPa
Where do emphysematous changes classically occur?
In the apices
