COPD Flashcards by Lisa McCulloch

what are the two types of COPD?

chronic bronchitis

emphysema

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what is required for a diagnosis of chronic bronchitis?

cough and sputum production on

most days for 3mo of 2 successive years

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what is required for a diagnosis of emphysema?

histological diagnosis of enlarged air

spaces distal to terminal bronchioles ̄c destruction of alveolar walls.

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state three causes of COPD?

􏰀 Smoking
􏰀 Pollution
􏰀 α1ATD (Alpha-1-antitrypsin deficiency (allows elastin to be broken down by elastase therefore tissue destruction)

Age

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state three clinical signs of hyperinflation of the chest?

􏰁 ↓Cricosternal distance (normal = 3 fingers)
􏰁 Loss of cardiac dullness
􏰁 Displaced liver edge

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which type of COPD has cyanosis ?

Pink Puffers in emPhysema

Blue Bloaters in chronic Bronchitis
- therefore chronic bronchitis

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does emphysema have increased or decreased alveolar ventilation?

increased alveolar ventilation

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does chronic bronchitis have increased or decreased alveolar ventilation?

decreased alveolar ventilation

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which type of COPD has breathlessness ?

emphysema

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what type of resp failure does chronic bronchitis develop into ?

Progress → T2 respiratory failure and cor pulmonale

- due to decreased alveolar ventilation

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what type of resp failure does emphysema develop into ?

Progress → T1 respiratory failure

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what are complications of COPD?

􏰀 Acute exacerbations ± infection
􏰀 Polycythaemia
􏰀 Pneumothorax (ruptured bullae)
􏰀 Cor Pulmonale
􏰀 Lung carcinoma

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what score is used to determine the severity of breathlessness?

mMRC Dyspnoea Score

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what are the 5 aspects of mMRC Dyspnoea Score?

Dyspnoea only on vigorous exertion
SOB on hurrying or walking up stairs
Walks slowly or has to stop for breath
Stops for breath after <100m / few min
Too breathless to leave house or SOB on dressing

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what two DD should be ruled out before a diagnosis of chronic bronchitis is made?

TB, bronchiectasis

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what morphological changes occur in the small and large airways?

Large Airways
• Mucous gland hyperplasia (increase in size)
• Goblet cell hyperplasia (cilia is lost and transparent goblet cells cover the epithelium)
• Inflammation and fibrosis is a minor component

Small Airways
• Goblet cells appear
• Inflammation and fibrosis in long standing disease (vessels lose shape and look jaggy/disorganized)

what will CXR show for COPD?

􏰁 Hyperinflation (> 6 ribs anteriorly)
􏰁 Prominent pulmonary arteries
􏰁 Peripheral oligaemia
􏰁 Bullae

what FEV1 measurements correlate with which severity of COPD?

􏰀 Mild: FEV1 >80% (but FEV/FVC <0.7 and symptomatic)

􏰀 Mod: FEV1 50-79%

􏰀 Severe: FEV1 30-49%

􏰀 Very Severe: FEV1 < 30%

what three bloods tests can be done for COPD?

FBC (polycythaemia), α1-AT level, ABG

what general measures can be addressed for COPD?

smoking cessation
- specialist nurse, nicotine replacement, Bupropion (partial nicotinic agonist)

pulmonary exercise

good diet and wt loss

influenza and pneumococcal vaccine

review once/twice a yr

air travel risky if FEV1<50%

what does LTOT stand for ?

Long-term oxygen therapy

what is the difference between asthma and COPD?

asthma is reversible

what patients would have long term oxygen therapy ?

Clinically stable non-smokers ̄c PaO2 <7.3

PaO2 7.3 – 8 + PHT / cor pulmonale / polycythaemia /
COPD
nocturnal hypoxaemia

Terminally ill pts.

what three things can be done in surgery for COPD?

􏰀 Recurrent pneumothoraces
􏰀 Isolated bullous disease
􏰀 Lung volume reduction

what type of drug is ipratropium?

Short-acting muscarinic antagonist (SAMA)

what medication can be given for COPD which has symptoms of Breathlessness and/or exercise limitation?

􏰀 SABA and/or SAMA (ipratropium) as required

what medication can be given for COPD which has symptoms of persistent breathlessness or exacerbations ?

􏰀 FEV1 >50%: LABA or LAMA (tiotropium) (stop SAMA) 􏰀 FEV1 <50%: LABA+ICS combo or LAMA

what type of medication is tiotropium?

Long-acting muscarinic antagonist (LAMA)

what medication can be given for COPD which has symptoms of persistent exacerbations or breathlessness?

􏰀 LABA+LAMA+ICS 􏰀 Roflumilast / theophylline (PDIs) may be considered 􏰀 Consider home nebs

what type of medication is theophylline?

xanthines - phosphodiesterase inhibitor, adenosine receptor blocker, and histone deacetylase activator. - smooth muscle relaxant

what 4 key questions should be asked about acute COPD exacerbation?

􏰀 Smoking status 􏰀 Exercise capacity 􏰀 Current treatment 􏰀 Previous exacerbations

what are DD for acute exacerbation of COPD?

􏰀 Pneumothorax 􏰀 Pulmonary oedema 􏰀 PE 􏰀 Asthma

what oxygen therapy should be given initially for acute exacerbation of COPD?

􏰀 24% O2 via Venturi mask: SpO2 88-92%, 􏰀 Vary FiO2 and SpO2 target according to ABG 􏰀 Aim for PaO2 >8 and ↑ in PCO2 of <1.5kPa

what can be nebulised during an acute exacerbation of COPD?

􏰀 Salbutamol 5mg/4h | 􏰀 Ipratropium 0.5mg/6h

what steroids can be given during an acute exacerbation of COPD?

􏰀 Hydrocortisone 200mg IV | 􏰀 Prednisolone 40mg PO for 7-14d

what antibiotic should be given if an infection is suspected with an acute exacerbation of COPD?

Doxy 200mg PO STAT then 100mg OD PO for 5d

what is the management for acute exacerbation of COPD with no response to treatment ?

􏰀 Repeat nebs and consider aminophylline IV 􏰀 Consider NIV (BiPAP) if pH<7.35 and/or RR >30 􏰀 Consider invasive ventilation if pH<7.26