COPD Flashcards
What is COPD?
Chronic Obstructive Pulmonary Disease
reatable( but not curable) chronic condition that is characterised by persistent resp symptoms and air flow restriction
What is the epidemiology of COPD?
- Data might underestimate
- 4th leading cause of death worldwide
- Prevalence 147 million worldwide, generally very common
What is the Aetiology of COPD?
- Smoking –> increases irritation of the airway and triggers inflammatory response
What are the risk factors for the development of COPD?
- Smoking
- Occupational exposure (dust fumes and chemicals)
- Air pollution (e.g. burning coal inside)
- Genetic
- alpha1-antitrypsin deficiency.
- Asthma
- Congenital abnormal lung development
How does choronic airway irritation lead to airway damage in COPD?
Leads to
- attraction of inflammatory cells that secrete damaging things (e.g. Elastase (Neutrophils), Metalloproteases + Oxidants (Macrophages)
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Which parts of the airway are affected by COPD?
- Chronic bronchitis
- Small airway fibrosis (<2mm)
- Emphysema in alveoli
What does chronic Bronchitis in COPD lead to?
- Overproduction of mucus
- Goblet cell hyperplasia
- Hypertrophy of submucosal gland
What does Small airway fibrosis in COPD lead to?
- Small airwasy collapse
- Become obstructed and stonsed due to fibrosis
What does emphysema in COPD lead to?
- Break down of elastiv tissue port of alveoli
- Increased air space, decreased tissue leading to decrease in gas exchanging surface area
What are the presenting symptoms of COPD?
- Chronic productive cought with clear or white sputum
- due to chronic bronchitis >3/12 for >2years
- Exertional SOB progressively worse
- Frequent Lower resp. tract infection
- Weight loss, anorexia, fatigue
- Due to hypoxia and increased effort to breath
- Chest tightness, wheezing
What are signs of COPD on examination?
- Cyanosis
- Hyperinflation
- Barrel chest
- Hyperresonance
- Decreased crico-sternal distance and expansion
- Quiet breath sounds
- Wheezing and basal crackels on auscultation
- Raised JVP (cor pulmonale)
- Pursed lip expiration
- Kachexia
- Ankle oedema
- Normally no haemoptysis and chest pain
What are the investigations you would do in a Patient with suspected COPD ?
- Spirometry
- CXR
- FBC (exclude anaemia of chronic disease)
- Heart
- BNP and ECG if suspected cor pulmonale
- Consider alpha-1 antitrypsin deficiency screening if COPD, young, no risk factors
What are the findings of Spirometry you would expect in a patient with COPD?
- Post-bronchodilator spirometry with FEV1/FVC <0.7
- reduced FEV and FEV1 with decreased FEV1/FEC ratio
- FEV1/FVC ration is used to determine GOLD stadium
What is a typical ECG of a pateint with Cor Pulmonale?
- Left shift
- right atrial and ventricular hypertrophy
Which findings would you expect on a CXR from a COPD patient?
- Hperinflation
- Flat hemidiaphragms, Large ventral pulmonary, arteries, decreased peripheral vascular markings, Bullar
What are possible complications of a patient with COPD?
- Reduced quality of life
- Acute exacerbations
- Cor pulmonale
- Frequent chest infection and ? Hospital admission
- Secondary Polycythaemia
- Resp failure
- Pneumothorax (if empyhsema ruptures)
What is the conservative management for COPD patients?
- Smoking cessation
- Pulmonary rehabilitation (tendency about more severe cases)
- Vaccination
- Influenza
- Pneumococcal
- Physiotherapy and Occupational Therapy
- Dietetic advise
- Psychology (if co-exiting mental health problems)
What is the medical management of Patients with COPD?
- Oxygen (if sats <88%, aim for 92%)
- SABA or SAMA (Short acting muscarinic antagonist
- If not work: LABA and LAMA
- If still no improvement: LABA + LAMA + ICS
- Long-term ABX to decrease risk of infection
When would you consider specialist referral for a Patient with COPD?
- Diagnostic uncertainty
- Severe COPD (<30% FEV1)
- >2 exacerbationn in one year
- Significant sputum burden
- Age <40 a1antit-deficienc<
- Sats <92%
- Weight loss of haemoptysis via 2 WW referal
What is the prognosis of a patient with COPD?
- Generally gradual decline with progressive loss of lung function
- Generally worse with
What are worse prognostic factors in COPD patients?
- Low FEV1
- Smoking
- Severer symptoms and burden
- Muscle wasting and low weight
- Increased hospital admission due to exacerbation
- Multimorbidity and frailty
What are the effects of LAMAs in COPD?
= Long acting muscarenic antagonis
- decreased mucus production
- airway dilation (decreased Smooth Airway muscle constriction)
