COPD Flashcards
what are the two types of COPD?
chronic bronchitis
emphysema
what is required for a diagnosis of chronic bronchitis?
cough and sputum production on
most days for 3mo of 2 successive years
what is required for a diagnosis of emphysema?
histological diagnosis of enlarged air
spaces distal to terminal bronchioles ̄c destruction of alveolar walls.
state three causes of COPD?
Smoking
Pollution
α1ATD (Alpha-1-antitrypsin deficiency (allows elastin to be broken down by elastase therefore tissue destruction)
Age
state three clinical signs of hyperinflation of the chest?
↓Cricosternal distance (normal = 3 fingers)
Loss of cardiac dullness
Displaced liver edge
which type of COPD has cyanosis ?
Pink Puffers in emPhysema
Blue Bloaters in chronic Bronchitis
- therefore chronic bronchitis
does emphysema have increased or decreased alveolar ventilation?
increased alveolar ventilation
does chronic bronchitis have increased or decreased alveolar ventilation?
decreased alveolar ventilation
which type of COPD has breathlessness ?
emphysema
what type of resp failure does chronic bronchitis develop into ?
Progress → T2 respiratory failure and cor pulmonale
- due to decreased alveolar ventilation
what type of resp failure does emphysema develop into ?
Progress → T1 respiratory failure
what are complications of COPD?
Acute exacerbations ± infection Polycythaemia Pneumothorax (ruptured bullae) Cor Pulmonale Lung carcinoma
what score is used to determine the severity of breathlessness?
mMRC Dyspnoea Score
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
what two DD should be ruled out before a diagnosis of chronic bronchitis is made?
TB, bronchiectasis
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
