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Respiratory > COPD > Flashcards

COPD Flashcards

1
Q

What is COPD?

A

COPD is airway obstruction without reversibility

It includes chronic bronchitis and emphesema

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2
Q

Describe the typical presentation of COPD

A 
> 35 years
Smoking or pollution related
Chronic dyspnoea
Sputum production
Minimal diurnal variation
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3
Q

What is chronic bronchitis?

A

Inflammation of the airways
Cough, sputum production on most days for 3 months of 2 successive years.
Symptoms improve if they stop smoking

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4
Q

What is emphysema?

A

Enlarged air spaces distal to the terminal bronchioles with destruction of alveolar walls

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5
Q

What are pink puffers and blue bloaters?

A

Pink puffers - have high alveolar ventilation, a near normal PaO2 and a normal or low PaCO2. They are breathless but not cyanosed. May progress to T1RF

Blue bloaters: Have reduced alvolar ventilation, low PO2 and high PCO2. They are cyanosed but not breathless and may go on to develop cor pulmonale. Their respiratory enters are insensitive to CO2 and they rely on hypoxic drive to maintain respiratory effort –> careful with oxygen supplementation.

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6
Q

What are causes of COPD?

A

Smoking!!

Alpha-1 antitrypsin
Coal
Cotton
Cement
Grain
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7
Q

What are symptoms and signs of COPD?

A

Cough, sputum, dyspnoea, wheeze

Tachypnoea, use of accessory muscles, hyperinflation, reduced cricosternal distance, barrel chest, reduced chest expansion, resonant or hyper resonant percussion note, quiet breath sounds, wheeze, cyanosis, cor pulmonale

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8
Q

What investigations in COPD?

A

Bedside
BMI
ECG - RVH in cor pulmonale

Bloods
FBC - exclude secondary polycythaemia
ABG - PaO2 ± hypercapnia

Imaging
CXR - hyperinflation, flat hemidiaphragms, large central arteries, reduced peripheral vascular markings, bullae

Other
Spirometry - obstruvtive: FEV1<80%,FEV1:FVC<70%, increased TLC, reduced DLCO
Post-bronchodilator spirometry to demonstrate non-reversible airway obstruction

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9
Q

How is COPD severity categorised?

A

Mild FEV1 > 80% but symptomatic and FEV1:FVC<70%
Moderate FEV1 50-79%
Severe FEV1 30-49%
Very severe FEV1 < 30%

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10
Q

What will spirometry show in COPD?

A

Obstructive pattern
FEV1 < 80% predicted
FVC normal or low
FEV1:FVC < 70% predicted

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11
Q

What is conservative management for COPD?

A 
Smoking cessation advice
Annual influenza vaccination
One off pneumococcal vaccination
Encourage exercise
Diet advice and supplements
Mucolytics may help chronic productive cough
Depression screen
Diuretics for oedema
Treat respiratory failure
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12
Q

What is initial management for COPD?

A

SABA (salbutamol) or SAMA (ipratropium)

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13
Q

What is the second step if patient remain breathless despite short acting bronchodilators?

A

FEV > 50
LABA (salmeterol) or LAMA (tiotropium)

FEV < 50
LABA + ICS (beclomethasone) in combined inhlaer
or LAMA

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14
Q

What is management for patients with persistent exacerbations of breathlessness?

A

If taking LABA switch to LABA + ICS combination inhaler

Otherwise give a LAMA and a LABA+ICS combination inhaler

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15
Q

What is recommended after trials of short and long acting bronchodilators or in people who cannot use inhaled therapy

A

Oral theophylline

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16
Q

What are features of cor pulmonale? How is it treated?

A

Peripheral oedema
Raised JV
Parasternal heave
Loud P2

Loop diuretic - furosemide for oedema
Consider LTOT
Note: no ACE-i, CCB or alpha blockage

17
Q

What factors improve survival in COPD patients?

A

Smoking cessation
LTOT for patients who fit criteria
Lung volume reduction surgery

18
Q

When is LTOT indicated? How long should LTOT receivers be on oxygen?

A
  1. Clinically stable non smokers with PaO2 < 7.3kPa despite maximal treatment - stable to 2 occasions 3 weeks apart
  2. IF PaO2 7.3-8 AND pulmonary hypertension (RVH, loud S2) or polycythaemia or peripheral oedema or nocturnal hypoxia
  3. Terminally ill patentees
19
Q

What organisms cause IECOPD?

A

Haemophilus influenzae
Streptococcus pneumonia
Moraxella catarrhalis

20
Q

How are IECOPD treated?

A

Increase frequency of bronchodilator use - consider giving via nebuliser
Prednisolone 30mg daily for 7-14 days
Abx

21
Q

What are complications of COPD

A 
IECOPD
Polycythaemia
Respiratory failure
cor pulmonale
Pneumothorax form ruptured bullae 
Lung carcinoma
22
Q

What is the MRC dyspnoea score?

A

1/ Not troubled by breathless ness except on strenuous exercise

  1. SOB when hurrying or walking up a slight hill
  2. Walks slower than contemporaries on level ground because of breathlessness
  3. Stops for breath after walking 100m on ground level
  4. Too breathless to leave the house or breathless when dressing

Respiratory (15 decks)

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