COPD Flashcards
What is COPD?
Irreversible deterioration in air flow through the lungs caused by damage to the lung tissue. It is not fully reversible with bronchodilators.
Name the causes of COPD.
- Smoking
- Occupational
- Alpha 1 Anti-trypsin deficiency
How does COPD present?
- Chronic dyspnoea
- Productive cough
- Wheeze
- Recurrent respiratory infections
- Smoking/occupational history
Which two symptoms is it unlikely to cause?
- Haemoptysis
- Chest pain
What is step 1 of the MRC dyspnoea scale?
Breathlessness only on strenuous exercise
What is step 2 of the MRC dyspnoea scale?
Breathlessness on a hill
What is step 3 of the MRC dyspnoea scale?
Breathlessness on a flat that slows you down
What is step 4 of the MRC dyspnoea scale?
Stops to catch breath every 100m on flat
What is step 5 of the MRC dyspnoea scale?
Housebound with breathlessness
How is diagnosis made?
Clinical presentation and spirometry
What will spirometry show?
Obstructive pattern
- reduced FEV1/FVC ratio
How is FEV1 used to grade COPD severity?
Stage 1- FEV1 <80% expected
Stage 2- FEV1 50-79% expected
Stage 3-FEV1 30-49% expected
Stage 4-FEV1 <30% expected
What might a FBC show?
Polycythaemia- raised haematocrit in response to chronic hypoxia
Name another test that may indicate COPD.
Transfer Factor for CO (TLCO)
- Decreased in COPD
- Increased in asthma and other conditions
What conservative measures are used for COPD?
- SMOKING CESSATION (single biggest improvement in survival)
- Chest physio
- Vaccines- flu and pneumococcal
- Education and MDT
What is P Pulmonale?
Peaked P wave indicating R atrial hypertrophy in cor pulmonale
What is step 1 in the medical management of COPD?
SABA or SAMA e.g. ipratropium bromide
What is step 2 in the medical management of COPD?
- Asthmatic/steroid responsive features
- No asthmatic/steroid response
Features absent- LABA + LAMA combi inhaler
Features present- LABA + ICS combi e.g. fostair, symbicort
What is step 3 in the medical treatment of COPD?
Triple combination inhaler (Trimbo)
- LABA + LAMA + ICS
What other therapies are available in unresponsive disease?
- Nebulisers
- Oral theophylline
- Mucolytics e.g. carbocisteine
- Prophylactic ABx e.g. azithromycin
- LTOT
What does a raised bicarbonate show on ABG?
Chronic CO2 retention
What SATs should you target?
88-92%
What value of resting pO2 should be referred to LTOT?
Less than or equal to 7.3kpa
What is type 1 respiratory failure?
- Low oxygen
- Low or normal CO2
What is type 2 respiratory failure?
- Low oxygen
- High CO2
Which type of respiratory failure does COPD normally cause?
Type 2
