COPD Flashcards by Jack Gorard

Define COPD

COPD is a progressive disorder characterised by airway obstruction with little or no reversibility, associated w/ an abnormal inflammatory response (typically to cigarette smoke)

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What conditions comprise COPD?

Chronic Bronchitis (inc airway resistance)
Bronchiolitis
Emphysema (dec outflow pressure)

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What is Chronic Bronchitis?

Inflammation of bronchi –> mucus production

Cough & sputum production on most days for 3/12 of 2 successive years

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What is Emphysema?

Enlarged air spaces distal to terminal bronchioles w/ destruction of alveolar walls but no fibrosis
Breathlessness

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What is bronchiolitis?

Inflammation of airways <2mm in diameter –> scarring and narrowing
-first change in COPD

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What are the pathological features of chronic bronchitis?

Hypertrophy/Hyperplasia of mucous glands

Frequent LRTIs - 2o inflammation, sq metaplasia

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What is the Reid index?

Ratio of gland:wall thickness in bronchus

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What causes alveolar destruction in emphysema?

Extracellular proteases (inflam cells)

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What is the most common form of emphysema?

Centrilobular emphysema

changes limited to central part of lobule
normal alveoli elswhere

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What is panacinar emphysema?

Destruction/distension of whole lobule

-more common in a1-antitryspin deficiency

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What are the risk factors for COPD?

Cigarette smoke exposure
Occupational dust exposure
a1-antritrypsin deficiency
Recurrent chest infections in childhood
Low socioeconomic status
Asthma/atopy

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How does COPD present?

Productive morning cough
Increased LRTIs
Progressive dyspnoea w/ wheeze
Resp failure
RHF (cor pulmonale)

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What are the signs of COPD?

Mild - widespread wheeze
Severe
- tachypnoea, cyanosis, flapping tremor
- hyperinflation, intercostal recession, resp distress
- raised JVP, poor chest exapnsion, hyper-resonant chest
- decreased breath sounds, prolonged exp phase, polyphonic wheeze
NEVER CLUBBING

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What are the common complications of COPD?

Acute exacerbations
Polycythaemia
Resp failure
Cor pulmonale
Pneumothorax
Lung carcinoma

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What are the two main groups of COPD pts?

Blue bloaters

Pink puffers

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What are blue bloaters?

Pts w/ severe COPD who are insensitive to CO2

Rely on hypxoic drive to stimulate resp effort

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What are the features of blue bloaters?

Not breathless

Cyanosed & oedematous

What ABG features are common in blue bloaters?

Type 2 resp failure

What is the key management difference in blue bloaters?

Give O2 w/ care, can compromise resp drive

What are pink puffers?

Pts sensitive to CO2

What are the features of pink puffers?

Tachypnoeic
Tachycardic
Breathless but not cyanosed
Can progress to Type 1 resp failure

What investigations are appropriate in suspected COPD?

Clinical diagnosis if typical sx in pt >35 w/ risk factor
Post-bronchodilator spirometry
CXR
FBC (anaemia, polycythaemia)
Sputum culture
ECG (RV hypetrophy)
ABG
DLCO

How can spirometry be used to stage COPD?

Stage 1 (mild) - FEV1 <80% predicted
Stage 2 (mod) - FEV1 50-79% predicted
Stage 3 (sev) - FEV1 30-49% predicted
Stage 4 (v. sev) - FEV1 <30% predicted

What features on CXR are suggestive of COPD?

Hyperinflation (6ant, 10post)
Flattened hemidiaphragms
Large central pulmonary aa
Reduced periph vasc markings
Bullae

What is the conservative management for stable COPD?

Refer to resp specialist if uncertain dx/worsening Patient education Action plan/rescue med for exacerbations Lifestyle advice (smoking cess)

What medications are used to treat stable COPD?

SABA/SAMA LABA/LAMA ICS

What are the 1st line medications for stable COPD?

SABA OR SAMA as required

What are the 2nd line medications for stable COPD?

FEV1>50% - Add LABA or LAMA (in place of SA) | FEV1<50% - Add LABA + ics & replace SAMA w/ LAMA

What are the 3rd line medications for stable COPD?

LAMA + LABA + ics

What are the specialist treatments for COPD?

``` Pulmonary rehabilitation Oral aminophylline/theophylline Mucolytics Nutritional supplementation LTOT ```

Describe pulmonary rehabilitation

Consider if person disabled by COPD Improves exercise/breathlessness/QOL 3 sessions/6 weeks

What are the indications for LTOT?

``` SpO2 <92% FEV1 <30% Cyanosis 2o polycythaemia Cor pulmonale ```

How much must LTOT be used by to increase survival?

>15h/day

How much does LTOT increase survival by?

3yr survival increased by >50%

What are the surgical options for COPD?

Pleurectomy Bullectomy Lung volume reduction surgery

What causes an acute exacerbation of COPD?

Bacterial/viral infections | Pollutants

When should hospital admission be considered for an acute exacerbation of COPD?

``` Severe breathlessness Rapid sx onset Acute confusion Cyanosis O2 sats <90% Worsening peripheral oedema ```

What outpatient management can be used for managing an acute exacerbation of COPD?

Increase dose/freq SABA Prednisolone 30mg for 7-14/7 Oral a/b if purulent sputum

What inpatient management can be used for managing an acute exacerbation of COPD?

O2 titrated to 88-92% sats | -28% venturi at 4L/min

What smoking cessation options are available for COPD pts?

National campaigns, advertisement bans, taxes Specialised clinics NRT/bupropion if >10/day

When should pharmacological treatments for smoking cessation be used?

Only in pts who commit to an initial stop date