COPD Flashcards
What is COPD?
Chronic disorder of airflow obstruction
What conditions make up COPD?
Emphysema and chronic bronchitis
What is emphysema?
Enlarged airspaces due to alveolar wall destruction - loss of elastin due to increased protease activity
What are features of chronic bronchitis?
Cough with sputum production most days for 3 months in 2 successive years
What is the pathophysiology of COPD?
Mucous gland hyperplasia
Loss of cilia
Chronic inflammation
Fibrosis of small airways
What causes COPD?
Smoking
Occupational exposure
α-1-antitrypsin deficiency
What are symptoms of COPD?
Cough
Dyspnoea
Wheeze
What do you find on examination of COPD?
Barrel chest Decreased chest expansion Hyper resonant percussion Reduced breath sounds Inspiratory crackles
What is the spirometry pattern?
Obstructive
FEV1 < 80% of predicted
FEV1/FVC <0.7
How is COPD classified?
Mild - FEV1 50-80% of predicted
Moderate - FEV1 30-49%
Severe - FEV1 <30%
How do you manage COPD conservatively?
Smoking cessation
Weight loss
Influenza vaccinations
Pulmonary rehabilitation
How do you manage mild COPD?
Anti-muscarinic PRN
B2 agonist PRN
How do you manage moderate COPD?
Regular anti-muscarinic OR LABA
+/- inhaled corticosteroid
How do you manage severe COPD?
Regular SABA
Anticholinergic
When is Long term oxygen therapy offered?
pO2 consistently <7.3
Non-smoker
Not retain CO2
How do you classify barrel chest on an x-ray?
> 8 anterior ribs OR >10 posterior ribs
How do you evaluate baseline?
MRC dyspnoea scale
COPD assessment test
What is the MRC dyspnoea scale?
1 Not troubled by breathless except on strenuous exercise
2 Short of breath when hurrying on a level or when walking up a slight hill
3 Walks slower than most people on the level, stops after a mile or so, or stops after 15 minutes walking at own pace
4 Stops for breath after walking 100 yards, or after a few minutes on level ground
5 Too breathless to leave the house, or breathless when dressing/undressing
What is the COPD assessment test?
Tool to assess how COPD affects every day life
Cough Phlegm Walking Daily activities Leaving house Sleep Energy
