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Respiratory > COPD > Flashcards

COPD Flashcards

1
Q

What are the causes?

A

Smoking
Air pollution
Occupational exposure - mining, building + chemical industries
A1AD

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2
Q

What are the two main types of COPD? what are its with them also known as?

A
  1. Emphysema - pink puffers

2. Chronic bronchitis - blue bloaters

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3
Q

What is emphysema?

A

Dilatation and destruction of lung tissue distal to terminal bronchioles ->
loss of elastic recoil ->
premature closure of airways limiting expiratory flow while loss of alveoli decreases capacity for gas transfer

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4
Q

What is chronic bronchitis?

A

Airway narrowing -> airflow limitation due to hypertrophy + hyperplasia of mucus secreting glands (goblet cells) of the bronchial tree -> XS mucus secretion
Decreased airflow, hyper secretion + chronic cough

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5
Q

Explain the pathophysiology of COPD

A

increased airway resistance

most have both emphysema and chronic bronchitis

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6
Q

Explain VQ mismatch in COPD

A

mismatch leads to fall in PaO2 and increased work

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7
Q

Explain how COPD leads to pink puffers

A

Normal CO2 maintained by increasing alveolar ventilation in an attempt to correct their hypoxia

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8
Q

Explain how COPD leads to blue bloaters

A

when pts lead to maintain resp effort and PaCO2 levels increase
In the short term rise in CO2 leads to stimulation of respiration
In longer term pts become insensitive to CO2 + depend on hyperaemia to drive ventilation
Renal hypoxia -> fluid retention + increased erythrocyte production -> polycythaemia
Leads to bloating and cyanosis - blue bloater

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9
Q

What are the resp symptoms?

A
  1. Cough - productive w white or clear sputum
  2. Wheeze
  3. SOB
  4. Colds settle on chest w frequent infections
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10
Q

What things worsen sx?

A

cold
damp weather
air pollution

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11
Q

What are systemic sx of COPD?

A 
HTN
Osteoporosis
Depression
WL
Reduced muscle mass due to generalised weakness
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12
Q

What is found on examination?

A
  • Barrel chest
  • Hyperresonance on percussion
  • Distant breath sounds on auscultation
  • Wheeze on auscultation (exacerbations)
  • Coarse crackles - mucus
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13
Q

What tests should be done?

A
  1. Spirometry: FV1/FVC ratio <0.7, post bronchodilator
  2. Sats - assess need for O2 therapy if FEV1 <50% of predicted
  3. CXR - rule out other Dx
  4. FBC
  5. Sputum culture
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14
Q

Explain how spirometry should be performed to diagnose and grade COPD

A

Carry out S 15-20 mins after inhaling salbutamol/terbutaline
Airflow obstruction = FEV1/FVC ratio <0.7
Severity
stage 1 - mild 80% or more of predicted value
Stage 2 - mod FEV1 50-79 of predicted value
Stage 3 - severe FEV1 30-49
Stage 4 - v severe FEV1 less than 30%

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15
Q

What is usually sen on CXR in cOPD?

A

hyperinflation

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16
Q

What are the differentials of COPD?

A 
Asthma
CCF
Bronchiectasis
TB
Bronchiolitis
Lung cancer
17
Q

How do COPD and asthma differ?

A

Asthma - early onset, Hx of allergy, daily variability in sx,
reversibility on spirometry w bronchodilators

18
Q

How do COPD and CCF differ?

A 
Hx of CVD present 
Orthopnoea 
Fine bibasilar inspiratory crackles 
NT-proBNP elevated
CXR - pulmonary vascular congestion
Echo confirms
19
Q

How do COPD and bronchiectasis differ?

A

Hx of recurrent infection in childhood
large volumes of purulent sputum
Clue: Hx fo pertussis or TB
Chest CT - bronchial dilation + wall thickening

20
Q

What is the conservative treatment of COPD?

A

Stop smoking
Pneumococcal and influenza vaccinations
Pulmonary rehabilitation
Optimise treatment for comorbidities

21
Q

Give the pharmacological treatment of COPD?

A
  1. SABA (salbutamol/terbutaline) or SAMA (ipratropium bromide)
  2. LABA (salmeterol/formeterol) or LAMA (tiotropium)
    Discontinue rx w SAMA if giving LAMA
  3. If asthmatic features - change to LABA + ICS
  4. If no asthmatic feature - LABA + LAMA
22
Q

What are the add on treatments?

A

Oral aminophylline or theophylline if still symptomatic after SABA and LABA
Mucolytic - for chronic productive cough
Oral corticosteroids + abx for exacerbations

23
Q

What are complications of COPD?

A
  1. Cor pulmonale
  2. Recurrent pneumonia
  3. Pneumothorax
  4. Respiratory failure
  5. Anaemia
  6. Polycythaemia
24
Q

How does COPD lead to cor pulmonale?

A

chronic hypoxia and subsequent vasoconstriction in pulmonary vasculature causing pulmonary HTN and R sided HF

25
Q

What are the signs of cor pulmonale?

A

Engorged neck veins
Loud P2
Lower extremity oedema
Hepatomegaly

26
Q

What is the management of cor pulmonale?

A

continuous O2 therapy

Judicious use of diuretics

27
Q

How do acute exacerbations of COPD present?

A

increasing cough, SOB or wheeze

decreased exercise capacity

28
Q

What ix would u do in an acute exacerbation of COPD?

A 
ABG
CXR - exclude pneumothorax + infection
FBC, U&amp;E, CRP
ECG
Sputum culture
Blood culture if fever
29
Q

Give the initial management of acute COPD

A
  1. Neb salbutamol 5mg/4h + ipratropium 500mcg/6hr
  2. Controlled O2 therapy if sats <88 or PaO2 <7
    Start at 24-28, aim for sats 88-92, PaO2 >8 and rise of PaCO2 <1.5
  3. IV hydrocortisone 200mg + oral pred 30mg (continue for 1-2w)
  4. Abx if infection
  5. Physio to aid sputum clearance
  6. IV aminophylline if no response
30
Q

Give the management of acute COPD if no response to initial therapy

A
  1. Non-invasive +ve pressure ventilation if RR>33 or pH <7.35 or PaCO2 rising
    or
  2. Resp stimulant drug if not suitable for ventilation
31
Q

When should intubation and ventilation be considered in rx of acute COPD?

A

if pH <7.26 and PaCO2 rising despite NIPPV

Respiratory (16 decks)

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