COPD Flashcards
What does it stand for?
What is COPD? What 2 diseases make up COPD?
What is the difference between COPD and asthma?
Chronic Obstructive Pulmonary Disease
Non-reversible airway obstruction with a combination of chronic bronchitis and emphysema
Asthma is reversible
Under what FEV1/FVC ratio is it then classed as airway obstruction i.e. COPD?
<0.7 (FEV1 <80% predicted)
Chronic bronchitis:
What is it? - think about the words
Main symptom
Over how many months does the symptom last for, before being classed as chronic bronchitis?
Over how many consecutive yrs does the symptom happen over, to be classed as chronic bronchitis?
What should the patient stop doing which would improve symptoms? - Lifestyle
Chronic excess mucus secretion in the bronchial tree
(Inflammation causes extra mucus secretion)
A productive cough + sputum - may begin as non-productive
> 3 months
2 consecutive yr
Smoking cessation
Emphysema:
What is used to diagnose emphysema? - done in 1st yr
What is it?
Where in the lung does it happen?
Why does it happen?
Histology
Enlarged air spaces
Beyond the terminal bronchioles
There is the destruction of alveolar walls without obvious fibrosis
What factors may increase your suspicion of COPD over asthma and other lung diseases?
Age of onset >35 yrs Smoking (passive/active) Pollution Chronic SOB - asthma is intermittent Sputum production Minimal diurnal/day-to-day FEV1 variation *****
Symptoms of COPD:
2 symptoms
What else may the patient complain of, especially when auscultating the chest?
Productive cough
SOB
Wheezing
Signs of COPD:
Why do they get tachycardia? - later sign
Why do they get tachypnoea?
COPD weakens your lungs and can cause hypoxia.
It’s harder for your heart muscle to get enough oxygen.
Tachycardia is compensation
COPD can make you prone to alterations in oxygen and carbon dioxide levels in the blood and/or lungs. When you have a low blood oxygen level (partial pressure of oxygen, pO2) your body may respond with rapid breathing as a way to obtain oxygen.
Examination of COPD patient:
What may you see on general inspection which indicates they are SOB?
Why do they get hyperinflation?
What does this look like on examination?
Why is there reduced chest expansion?
Why may the lungs be hyper resonant on percussion?
Use of accessory muscles
They are unable to get all the air out of the lungs due to:
- Chronic bronchitis (inflam + mucus production narrowing airways)
- Emphysema (alveoli damaged so more air is trapped as air spaces larger)
Barrel chest
Due to hyperinflation - less air is able to get in if there is already air there.
There is more air due to hyperinflation
Examination of COPD patient:
Why do they have quiet breath sounds?
Why do they have a reduced cricosternal distance?
Why could they be cyanosed?
Why does hypoxia eventually lead to cor pulmonale? - it is not strain on heart because of lack of O2 supply
Paradoxical inspiratory retraction of lower ribs and intercostal spaces happens in COPD. What is this called?
Hyperinflation
Hyperinflation
Reduced ability to inflate the lungs
Less oxygen transfer
Smaller V/Q ratio (V becomes a lot smaller)
Sustained hypoxia activates rho kinase, reinforcing vasoconstriction, and hypoxia-inducible factor (HIF)-1α, leading to adverse pulmonary vascular remodelling and pulmonary hypertension (PH).
This increase in pressure places excess strain on the heart’s right ventricle as it works to pump blood through the lungs
HOOVERS SIGN - LOOK UP
Investigations:
Pulmonary function testing - Spirometry:
- Under what value is the FEV1/FVC ratio in COPD?
- Which part of the ratio decreases more?
- What about the TLC?
- Why is it done after bronchodilators?
Asthma has normal oxygen transfer whereas COPD has reduced oxygen transfer due to less ventilation and reduced surface area from emphysema. What can be used to measure the efficiency of oxygen transfer?
<0.7
FEV1
TLC goes up - hyperinflation
To rule out asthma as there would be full reversibility with asthma
DLCO - diffusing capacity of the lung for CO
Investigations:
ABG - what 2 things are you looking for which suggests COPD? - think about what it involves?
CXR - what on the XR would indicate there is hyperinflation? How might you see emphysema? How may cor pulmonale be seen?
Why is an ECG done?
Low PaO2
Raised PaCO2 - hypercapnia
> 6 anterior ribs
Flat and tented diaphragm
Bullae - lookup
Loss of lung markings (emphysema)
Cardiomegaly
Can see RVH
Management - Lifestyle and Preventative:
What needs to be stopped if they already do it?
What do they need to keep on top of to prevent exacerbations?
Smoking - it slows decline and increases survival
Their vaccines (flu and pneumococcal)
Stepwise medical management:
Step 1 - 2 PRN inhalers used - SABA and SAMA (bronchodilators).
- What do they stand for?
- Give a name for each?
Short-acting beta-agonists - Salbutamol (used as all stages)
Short-acting muscarinic antagonists - Ipratropium
Stepwise medical management:
Step 2 - If FEV1>50%:
- 2 meds are used together, LABA + LAMA. What do they stand for?
- Give a name for each?
Step 3 - If FEV1<50%:
- 3 meds are used together, LABA + LAMA + ICS. What do they stand for?
- Give a name for each?
Long-acting beta-agonists - Salmeterol
Long-acting muscarinic antagonists - Tiotropium
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Long-acting beta-agonists - Salmeterol
Inhaled corticosteroids - Beclometasone
Long-acting muscarinic antagonists - Tiotropium
Look up Seretide or Symbicort
Stepwise medical management:
Step 3 - Triple therapy:
- Which 3 do you think is used?
LABA + LAMA + ICS
