COPD Flashcards
Chronic Obstructive Pulmonary Disease (COPD) - Definition
Disease process which causes chronic mechanical outflow obstruction through bronchospasm and decreased elasticity of lung tissue
Goal of Care
Improve airflow through the medium and small airways and transport to hospital
Overview
COPD has two dominant forms
Emphysema (pink puffers): characterized by an abnormal enlargement of the air spaces distal to the terminal bronchioles accompanied by the destruction of their walls
Chronic Bronchitis (blue bloaters): characterized by inflamed and edematous airways filled w/ secretions. Copious respiratory secretions contribute to expiratory obstruction
Overview - Exacerbations
Exacerbaions of pre-existing COPD can be defined as the following
- Increased dyspnea
- Increased cough
- Increased sputum production
It is critical to recognize that there may be little or no air flow in severe COPD exacerbations with the result being minimal audible wheezing
- In cases of severe bronchospasm, audible wheezing may be absent prior to treatment
- in these cases, the onset of wheezing
following treatment may be indicative
of improved airflow
It is also important to note that the complete removal of wheeze in these pts may not be possible due to chronic airway disease
Overview - Features of a Severe Attack
History
- Recent exacerbation or pneumonia
- Hx of non-compliance w/ treatment
- Previous life-threatening episodes including admissions to the ICU or hx of intubation
- Increasing frequency of beta-agonist use - the pt who has used his or her puffer many times in the past day or two
Physical
- Upright or forward sitting (tripod) position
- Difficulty speaking full sentences - the fewer words at a time, the worse the situation
- Pursed-lip breathing
- Decreased O2 sats
- No wheeze - this may be a sign of no air entry at all (silent chest).
If there is good air entry but ino wheeze, this could be a sign that the respiratory distress is due to another serious condition (PE). Never assume that pts in resp distress w/ good quality of air entry are not suffering from a serious condition
Guiding Principles
Pts w/ failing respirations require support. Often a little supportive ventilation can dramatically improve the pts condition as it provides appropriate ventilation, oxygenation and decreases the work of breathing
CPAP is a form of non-invasive positive pressure ventilation which can be very beneficial in bronchospasm as a result of COPD
CPAP does not replace bronchodilator (salbutamol) therapy. If pt is experiencing signs of bronchoconstriction
- expiratory wheeze
- increased inspiratory/expiratory ration
- accessory muscle use
then bronchodilators should be initiated as per conventional practice
Special Note
Intubation should only be required in the most exceptional cases
Intubating an asthmatic is a last resort since the introduction of the tube can dramatically increase bronchospasm in an already compromised patient.
COPD patients do not do well when intubated and ventilated. It is often difficult to wean these patients off a ventilator
Other Considerations
Droplets from nebulizatoin can carry virus particles
For pts w/ a fever (subjective) and a mild to moderate wheeze, consider transport w/o admin nebs.
Always wear PPE when treating a coughing pt
D/c the neb prior to entering the facility and until triaged to an appropriate bed
Intervention Guidelines - EMR/PCP
EMR
Position the pt upright
Supp O2
Positive Pressure Ventilation (PPV) for failing resps
PCP
All above, plus;
Bronchodilation as requied:
- Salbutamol - 5mg via neb - repeat as required - no max dose
or 4 x 100mcg dose via MDI
CPAP as required
- mandatory call to CliniCALL
Intervention Guidelines - ACP
Anticholinergic therapy
- Ipratropium - 0.5mg via neb w/ conjunction w/ salbutalmol
Intubation as per Adult Induction Guidelines
Further Care
COPD Exacerbation:
- Antibiotics
- Steroids
- Non-invasive Ventilation (CPAP/BiPAP)
- Methylxanthines
