COPD Flashcards
What is COPD?
COPD is airway obstruction without reversibility
It includes chronic bronchitis and emphesema
Describe the typical presentation of COPD
> 35 years Smoking or pollution related Chronic dyspnoea Sputum production Minimal diurnal variation
What is chronic bronchitis?
Inflammation of the airways
Cough, sputum production on most days for 3 months of 2 successive years.
Symptoms improve if they stop smoking
What is emphysema?
Enlarged air spaces distal to the terminal bronchioles with destruction of alveolar walls
What are pink puffers and blue bloaters?
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.
What are causes of COPD?
Smoking!!
Alpha-1 antitrypsin Coal Cotton Cement Grain
What are symptoms and signs of COPD?
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
What investigations in COPD?
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
How is COPD severity categorised?
Mild FEV1 > 80% but symptomatic and FEV1:FVC<70%
Moderate FEV1 50-79%
Severe FEV1 30-49%
Very severe FEV1 < 30%
What will spirometry show in COPD?
Obstructive pattern
FEV1 < 80% predicted
FVC normal or low
FEV1:FVC < 70% predicted
What is conservative management for COPD?
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
What is initial management for COPD?
SABA (salbutamol) or SAMA (ipratropium)
What is the second step if patient remain breathless despite short acting bronchodilators?
FEV > 50
LABA (salmeterol) or LAMA (tiotropium)
FEV < 50
LABA + ICS (beclomethasone) in combined inhlaer
or LAMA
What is management for patients with persistent exacerbations of breathlessness?
If taking LABA switch to LABA + ICS combination inhaler
Otherwise give a LAMA and a LABA+ICS combination inhaler
What is recommended after trials of short and long acting bronchodilators or in people who cannot use inhaled therapy
Oral theophylline
What are features of cor pulmonale? How is it treated?
Peripheral oedema
Raised JV
Parasternal heave
Loud P2
Loop diuretic - furosemide for oedema
Consider LTOT
Note: no ACE-i, CCB or alpha blockage
What factors improve survival in COPD patients?
Smoking cessation
LTOT for patients who fit criteria
Lung volume reduction surgery
When is LTOT indicated? How long should LTOT receivers be on oxygen?
- Clinically stable non smokers with PaO2 < 7.3kPa despite maximal treatment - stable to 2 occasions 3 weeks apart
- IF PaO2 7.3-8 AND pulmonary hypertension (RVH, loud S2) or polycythaemia or peripheral oedema or nocturnal hypoxia
- Terminally ill patentees
What organisms cause IECOPD?
Haemophilus influenzae
Streptococcus pneumonia
Moraxella catarrhalis
How are IECOPD treated?
Increase frequency of bronchodilator use - consider giving via nebuliser
Prednisolone 30mg daily for 7-14 days
Abx
What are complications of COPD
IECOPD Polycythaemia Respiratory failure cor pulmonale Pneumothorax form ruptured bullae Lung carcinoma
What is the MRC dyspnoea score?
1/ Not troubled by breathless ness except on strenuous exercise
- SOB when hurrying or walking up a slight hill
- Walks slower than contemporaries on level ground because of breathlessness
- Stops for breath after walking 100m on ground level
- Too breathless to leave the house or breathless when dressing
