COPD Flashcards
What is the leading cause of COPD?
Smoking
Classic presentation of COPD
wheezing, productive cough, dyspnea on exertion, hypoxia, and tachycardia, sputum change in color or quantity, fever/chills
What are reasons to aggravate someones COPD?
Superimposed infection Continued smoking Non-compliance Lack of usual medications or oxygen therapy Spontaneous pneumothorax
Typical physical exam findings of COPD?
Pursed lip breathing Cyanosis Use of accessory muscles Intercostal retractions Barrel chest Hyper-resonant chest Wheezing Prolonged expiratory phase Tachycardia
Initial treatment
Oxygen. Apply controlled oxygen to all hypoxic patients who present with suspected COPD
Initial diagnostic things
In the ED, obtaining a chest x-ray, electrocardiogram, BNP (brain naturetic peptide), ABG (arterial blood gas), and cardiac markers may be necessary.
Common CXR findings
increased AP diameter, flattening of the diaphragm, decreased lung markings and the absence of another acute abnormality, such as pneumothorax, pulmonary edema or infiltrate
Common EKG findings
Low voltage, right axis deviation and rightward axis deviation
P pulmonale- peaked P waves in II, III, aVF
Right atrial hypertrophy
Tachycardia
Multifocal atrial tachycardia (rare, but specific to COPD)
What is the general treatment?
In general, treatment revolves around use of bronchodilators, corticosteroids, and antibiotics to treat superimposed infection.
Best bronchodilator
SABA: Albuterol
Only real limiting factor is tachycardia
Other first line
Use of anti-cholinergic bronchodilators such as ipatropium bromide, is also first line therapy. Ipatropium is typically given every 4 hours, not in stacked or repeated doses like albuterol.
Steroids
An IV steroid such as methlyprednisolone or prednisone orally should be started in the ED to help treat the inflammatory component.
Major side effects to steroids
Corticosteroids have been shown to reduce treatment failure, hospital stay, and the need for additional medical therapy. Complications of steroid use are worsening hypertension, elevated blood sugars, gastritis, and even steroid psychosis.
Antibiotics?
Empiric antibiotics are used if signs of infection are present and in patients with moderate to severe exacerbations. Exam and historical features that suggest infection are fever, color change of sputum, and increased volume of sputum.
Choice of antibiotic
macrolides, fluoroquinolones, tetracyclines and cephalosporins.
