COPD Flashcards
What is COPD?
Progressive airway obstruction characterized by enhanced airway inflammation and edema, with increased airflow limitation and gas exchange defects.
Name risk factors for COPD
Smoking (major RF), occupational dust, chemical exposure
What questions are important on COPD history in the ED?
Hx of premorbid functional status, severity of airflow limitation (FEV1), duration of symptoms, # previous episodes and hospitalizations, co-morbidities, current tx regimen, previous need for mechanical support
Signs of COPD on PEx
Rapid, shallow, pursed lip breathing. Wheezing, decreased breath sounds. Accessory muscle use. Paradoxical chest wall movement. Central cyanosis. Peripheral edema, RV failure. Hemodynamic instability. Decreased O2 sat. Decreased LOC, confusion.
What are the hallmarks of COPD exacerbation?
increased SOB, increased cough frequency/severity, increased sputum volume/purulence.
Initial investigations for COPDE
CXR, EKG, ABC (VBG), CBC, routine chemistry
Describe the use of oxygen in the context of a COPDE
Oxygen delivery should be guided by pulse oximetry, target saturation 88-92%.
Goal PaO2 60-65 mmHg.
Can use venturi mask to offer more precise O2 concentration.
Beware of CO2 retainers whos resp drive may be suppressed by higher [O2] leading to CO2 narcosis, acidemia and eventual respiratory arrest.
Describe the utility of bronchodilators in COPDE
Ventolin: inhaled b2 agonist. Give 2.5-5mg by neb q15 min x3 prn or 4-8 puffs by MDI q15 min x3 prn.
Atrovent: 500 mcg by neb q15 or 4-8 puffs q15.
ABC: no diff between MDI and neb. HOWEVER, my teaching is MDI = better drug delivery than neb.
No role for long acting B2 agonists in acute setting.
Describe 6 frequent ‘meds’/internvetions for COPDE
1) Oxygen (titrate to 88-92%)
2) Ventolin (4-8 puff q15 or neb)
3) Atrovent (4-8 puff q15 or neb)
4) Steroids (125 mg methylpred or 50 pred)
5) Antibiotics
6) NIPPV (CPAP/BiPAP)
Describe utility of steroids in COPDE
Systemic steroids shorten recovery time, improve lung function, reduce risk of early relapse and length of oxygen stay.
Oral equal to IV in most exacerbations.
Give IV methylpred 125 BID-QID or PO pred 50 7-14 days.
No good evidence for inhaled steroids acute setting.
Describe utility abx in COPDE
Give if all 3 symptoms COPDE present or mechanical ventilation required.
Usual length 5-10 days.
Options:
Macrolide- e.g. azithromycin
2nd/3rd gen cephalosporin (cefuroxime, cefixime), doxycycline, septra.
Utility NIPPV
Stents open airways, preventing air trapping and allowing for CO2 removal.
Good evidence for reduction of mortality and intubation rates.
Consider using if significant respiratory acidosis, CO2 retention or severe dyspnea with signs of fatigue.
When to intubate in COPDE
Unable to tolerate or fails NIPPV. Altered LOC, severe agitation, unable to cooperate. High aspiration risk. Life threatening hypoxemia. Cardiovascular instability. Respiratory or cardiac arrest.
