copd Flashcards
what is copd ?
it is a chronic obstructive disease common characterised by the limitation of airflow which s usually progressive preventable and treatable disease
but not fully reversible
chronic bronchitis
emphysema - destruction of the elastic component in lung alveoli - leading to permanent enlargement of air space
with or without fibrosis
small airway disease
what is the classification of copd
gold staging
spirometry classification
pulmonary function test done
FEV1 (over 1 second)
and FVC
normal
more than 80 percent forced expiratory volume
FEV1 /fvc > 0.7
fev1 - over 80 percent
obstructive
FEV1/ FVC <0,7 obstructive lung disease
clinical manifestations of COPD
cough up sputum early in the morning
dyspnea - pursed lip breathing
wheezing
chest tightness
cachexia
physical exam
hyperesonant precussion
diffculty to detect heart apex beat
neck vein distended
central cynosis - bluish in mucosal membranes
barrel chest - horizontal ribs and protruding abdomen
s3 gallop
hollow systolic murmur - tricuspid regurgitation
resting respiratory rate - more than 20 beats per min
resting muscle activation whilst lying supine - scalene and sternocleidomastoids
what are other obstructive lung disease ?
bonchal asthma
bronchiectasis
how do you diagnose COPD ?
cat test (copd assessment test) health status
MMRC - modified medical research council - dyspnea scale
spirometry - breath normally and suddenly blow out as much breath as you can
normal breath then deep breath
all chronic obstructive pulmonary disease has less FEV1/FVC less than 0.7
stage 1 - FEV1 over 80percent predicted
stage 2 - fev1 50-80 percent
stage 3 - fev1 30-50 percent
stage 4 severe - FEV1 less than 30 percent
CT / CHEST X RAY - retrosternal space is enlarged widely spaced ribs flattening of diaphragm and increased lung markings hyperinflation
ct emphysema - bullae
abc gas analysis must be performed in patients who have FEV1 <40 PERCENT
for respiratory failure
respiratory acidosis
and po2 is really low
3 stages for respiratory failure
hypoema
hypercapnea + hypoxia
resiratory acidosis + hypercapnea + hypoxia
bronchodilator reverisibility test
contraindication spirometry ?
hemoptesis
pneumothroax
children under 6
what is the management of copd
combined assessment of copd
tells severity
and treatment
4 )
spiro 3 c ) d >2
risk ---------------- excac
2 a ) b 2
1 ) 1
mMRC 0-1 mMRC >2
CAT <10 Cat >10
what is the treatment of copd ?
smoking cesstation
stop working
STEP UP TREATMENT - by the severity of the disease
these are all below bronchodilators
stable copd - ABCD
A - short acting b2 agonist
relaxes bronchial smooth muscle
salbutamol
adverse - tremor , cough , dry mouth
or short acting muscuranic antagonist - acetylcholine inhibitors - on the smooth muscle
ipratropium bromide
adverse - sinusitis , dry mouth
prostatic symptoms
second line
conditions get worst
second line
LABA - long acting
formeterol
LAMA - long acting
tiotropium
1 corticocsteroid - declomethazone- inhaled
predensone - systemic
B
LAMA /LABA
C
corticosteroid with lama or laba
second choice - lama + phosphodiesterase 4 inhibitor - roflumilast
non selective phosphidisterase inhitior - methyxanthines - theophyline
adverse - atrial and ventricular arrythmia
d - same as C
antibiotic therapy - tetracyclin , ampicllin
mucolytics - ambroxol - very small benefits
oxygen therapy in stage 5
pao2 below 55mmhg
bullectomy
lung volume reduction surgery - making respiratory muscles more effective pressure generators
copd excaerbation is caused by what
caused by infections or cold weather
what is the treatment for COPD
LABA + LAMA
exacerbation - check blood esoniophilic count - less than 100
roflumilast
blood eosinophilic count more than 100- add corticosteroids
what would you do for acute repertory failure ?
non ivasive mechanical ventilation - ocygen therapy
what are the different types of emphysema ?
centriacinar
panacinar
paraseptal - involves the peripheral alveoli , along visceral pleura
irregular emphysema- occurring when extensive scarring
what is the aetiology of COPD ?
smoking - impairing cillary movement ,
inhibits alveolar function
hypertrophy of mucus secreting glands
neutrophils
inhibits a1 antitryspin too
air pollutants indoor and outdoor - dust and noxious gases
infections
genetic - alpha 1 antitrypisn deficiency
what is the pathology in chronic bronchitis
overproduction in mucus
metaplastic goblet cells
squamous cell metaplasia - no cillia - lead to infections
complication of emphysema
cor pulmonale
