COPD Flashcards
Define COPD?
Chronic, progressive lung disorder characterised by airflow obstruction, with Chronic Bronchitis and Emphysema
What is Chronic Bronchitis?
Chronic cough and sputum production on most days for at least 3 months per year over 2 consecutive years
What is Emphesema?
Pathological diagnosis of permenant destructive enlargement of air spaces distal to the terminal bronchioles
What is the normal cause of COPD?
Bronchial and Alveolar damage is caused by environmental toxins (e.g. cigarette smoke)
What is a rare cause of COPD?
a1 antitrypsin deficiency
When would you consider a1 antitrypsin deficiency as a cause of COPD?
Though this is rare, consider it in young patients, who have never smoked, presenting with COPD type symptoms (and may have accompanying symptoms of cirrhosis)
What occurs in Chronic Bronchitis?
Narrowing of the airways resulting in bronchiole inflammation (bronchiolitis)
Bronchial Mucosal Oedema
Mucous Hypersecretion
Squamous metaplasia
What occurs in Emphysema?
Destruction and enlargement of alveoli
Leads to loss of elasticity that keeps small airways open in expiration
Progressively larger spaces develop called bullae (diameter > 1 cm)
What is the epidemiology of COPD?
VERY COMMON (8% prevalence) Presents in middle age or later More common in males - this may change because there has been a rise in female smokers
What are the presenting symptoms of COPD?
Chronic Cough Sputum Production Breathlessness Wheeze Reduced Exercise Tolerance
What are signs of COPD you with see in a physical examination on inspection?
Respiratory Distress Use of Accessory Muscles Barrel-shaped over-inflated chest Decreased cricosternal distance Cyanosis
What are signs of COPD you with see in a physical examination on percussion?
Hyper-resonant chest
Loss of Liver and Cardiac Dullness
What are signs of COPD you with see in a physical examination on ausculation?
Quiet Breath sounds Prolonged expiration Wheeze Rhonchi Sometimes crepitations
What are Rhonchi?
Rattling, continuous and low-pitched breath sounds that sound a bit like snoring
They are often caused by secretion in larger airways or obstructions
What are crepitations?
Crepitation refers to situations where noises are produced by the rubbing of parts one against the other
Creaking
What are the early signs of CO2 retention?
Bounding Pulse
Warm peripheries
Asterixis
What are some of the late signs of CO2 retention?
Signs of right heart failure (cor pulmonale)
Right Ventricular Heave
Raised JVP
Ankle Oedema
What would we see on a spirometry and in Pulmonary Function Tests in COPD?
Shows obstructive picture Reduced PEFR Reduced FEV1/FVC Increased Lung Volumes Decreased CO gas transfer coefficient
What would you see on a CXR for COPD?
May appear normal
Hyperinflation (> 6 anterior ribs, flattened diaphragm)
Reduced peripheral lung markings
Elongated cardiac silhouette
What would you expect to see in bloods for COPD?
FBC - increased Hb and haematocrit due to secondary polycythaemia
What might you see in ABG for COPD?
May show Hypoxia, normal/raised PCO2
What would you check for on an ECG or an Echocardiogram for COPD?
Check for cor pulmonale
When would we do Sputum and Blood cultures in COPD?
Useful in acute infective exacerbations
When would we do a1 antitrypsin levels in COPD?
Useful in young patients who’ve never smoked
What is the important first step in any management plan for COPD?
STOP SMOKING
What Bronchodilators would you use in COPD?
Short-acting Beta-2 agonists (e.g. salbutamol)
Anticholinergics (e.g. ipratropium bromide)
Long-acting beta-2 agonists (if> 2 exacerbation per year)
What steroids would you use in COPD?
Inhaled beclamethasone
Regular oral steroids should be avoided if possible
When do we consider Inhaled Beclamethasone?
Considered in all patients with FEV1 < 50% of predicted or > 2 exacerbations per year
What are the 2 other possible management options in COPD?
Pulmonary Rehabilitation
Oxygen Therapy - only for those who stop smoking
When is Oxygen Therapy indicated?
PaO2 < 7.3 kPa on air during a period of clinical stability
PaO2 is &.3-8 kPa and signs of secondary polycythaemia, noctural hypoxaemia, peripheral oedema or pulmonary hypertension
What is the treatment for Acute Exacerbations?
24% O2 via Venturi mask
Increase slowly if no hypercapnia and still hypoxic (do an ABG)
Corticosteroids
Start empirical antibiotic therapy if evidence of infection
Respiratory Physiotherapy to clear sputum
Non-invasive ventilation may be necessary in severe cases
How do you prevent infective exacerbations?
Pneumococcal and influenza vaccination
What are the possible complications of COPD?
Acute respiratory failure Infections Pulmonary Hypertension Right Heart Failure Pneumothorax (secondary to bullae rupture) Secondary Polycythaemia
What is the prognosis for patients with COPD?
High Morbidity
3-year survival of 90% if < 60 years, FEV1 > 50% predicted
3-year survival of 75% if > 60 years, FEV1: 40-4(% predicted
