COPD Flashcards
Define COPD
Chronic, progressive lung disorder characterised by airflow obstruction, with the following:
Chronic Bronchitis
Chronic cough and sputum production on most days for at least 3 months per year over 2 consecutive years
Emphysema
Pathological diagnosis of permanent destructive enlargement of air spaces distal to the terminal bronchioles
Explain the aetiology/risk factors of COPD
Bronchial and alveolar damage is caused by environmental toxins (e.g. cigarette smoke)
RARE CAUSE:
a1 antitrypsin deficiency
Though this is rare, consider it in YOUNG NON SMOKERS - presenting with COPD type symptoms (and may have accompanying symptoms
of cirrhosis)
What is chronic bronchitis?
NARROWING of the airways resulting in bronchiole inflammation (bronchiolitis)
Bronchial mucosal OEDEMA
MUCOUS hypersecretion
Squamous METAPLASIA
What is emphysema?
DESTRUCTION AND ENLARGEMENT of alveoli
Leads to loss of ELASTICITY that keeps small airways open in expiration
Progressively LARGER SPACES develop called bullae (diameter > 1 cm)
Summarise the epidemiology of COPD
VERY COMMON (8% prevalence)
Presents in middle age or later
More common in MALES
(this may change because there has been a rise in female smokers)
Recognise the presenting symptoms of COPD
Chronic cough Sputum production Breathlessness Wheeze Reduced exercise tolerance
Recognise the signs of COPD on physical examination
INSPECTION Respiratory distress Use of accessory muscles Barrel-shaped over- inflated chest Decreased cricosternal distance Cyanosis
PERCUSSION
Hyper-resonant chest
Loss of liver and cardiac dullness
AUSCULTATION Quiet breath sounds Prolonged expiration Wheeze Sometimes crepitations Rhonchi - ((rattling, continuous and low- pitched breath sounds that sounds a bit like snoring. They are often caused by secretions in larger airways or obstructions ))
SIGNS OF CO2 RETENTION
Bounding pulse
Warm peripheries
Asterixis
What is the normal cricosternal distance?
3-4 fingers between cricoid cartilage and sternum
It’s increased in COPD
What are late stages signs of COPD?
SIGNS OF RIGHT HEART FAILURE (ie: cor pulmonale)
Right ventricular heave
Raised JVP
Ankle oedema
LIST appropriate investigations for COPD
Spirometry and Pulmonary function tests CXR Bloods ABG ECG and Echocardiogram Sputum & Blood cultures a1-antitrypsin levels
What are the observations of bloods in COPD?
FBC - increased Hb and haematocrit due to
secondary polycythaemia
What are the observations in a CXR in COPD?
May appear NORMAL
Hyperinflation (> 6 anterior ribs, flattened
diaphragm)
Reduced peripheral lung markings
Elongated cardiac silhouette
What are the observationsof Spirometry and PFT in COPD?
Shows obstructive picture:
Reduced PEFR
Reduced FEV1/FVC
Increased lung volumes
Decreased carbon monoxide gas transfer coefficient
Generate a management plan for COPD
CONSERVATIVE: stop smoking !!!
MEDICINE:
- Bronchodilators
- SABA’s : Short-acting beta- 2 agonists (e.g. salbutamol)
- Anticholinergics (e.g. ipratropium bromide)
- LABA’s : Long-acting beta-2 agonists (if > 2 exacerbations per year)
- Steroids: Inhaled beclamethasone - considered in all patients with FEV1 < 50% of predicted OR
> 2 exacerbations per year Regular oral steroids should be avoided if possible
- Pulmonary rehabilitation
- Oxygen therapy
Only for those who stop smoking
Indicated if:
PaO2 < 7.3 kPa on air during a period of clinical stability
PaO2: 7.3M8 kPa and signs of secondary polycythaemia, nocturnal hypoxaemia, peripheral oedema or pulmonary hypertension
-Prevention of infective exacerbations: pneumococcal and influenza vaccination
Management of acute exacerbations of COPD
- 24% O2 via Venturi mask - increase slowly if no hypercapnia and still hypoxic (do an ABG)
- Corticosteroids
- Start empirical antibiotic therapy if evidence of infection
- Respiratory physiotherapy to clear sputum
- Non-invasive ventilation may be necessary in severe cases
