COPD Flashcards

1
Q

Define COPD

A

Chronic progressive irreversible lung disorder characterised by airflow obstruction, chronic bronchitis and emphysema

Chronic Bronchitis: Chronic cough and sputum production on most days for at least 3 months per year over 2 consecutive years

Emphysema: permanent destructive enlargement of air spaces distal to the terminal bronchioles

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2
Q

Aetiology of COPD

A

Bronchial and alveolar damage due to environmental toxins i.e. smoking
May be caused by alpha-1 antitrypsin deficiency (<1%)
May overlap and co-present with asthma

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3
Q

Aetiology of chronic bronchitis and emphysema

A

Bronchitis: narrowed airways due to inflammation and mucosal oedema, hypersecretion and squamous metaplasia

Emphysema: destruction and enlargement of alveoli -> loss of elastic traction that keeps them open -> collapse -> bullae formation

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4
Q

Risk factors for COPD

A

Cigarette smoking, >65, genetic factors, exposure to air pollution, occupation, Male, RA

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5
Q

Epidemiology of COPD

A

Common in elder people >65
Global prevalence 17.5% M and 9.3% F
Deaths from COPD increasing
Prevalence in never-smokers is 12.2%

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6
Q

Symptoms of COPD

A
Cough (productive, continuous, chronic)
SOB
Fatigue 
Wheeze
Weight or muscle loss
Headache 
Reduced exercise tolerance
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7
Q

Signs of COPD on exam

A
Tar staining 
Hyperexpanded chest 
Reduced expansion 
Asterixis 
Tachypnoea/resp. distress
Tripod position, use of accessory muscles, pursed lip breathing 

Reduced breath sounds
Hyperresonance
Wheeze
Coarse crackles

Signs of RHF (Cor Pulmonale)

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8
Q

Investigations for COPD

A

Spirometry and PFTs - FEV1/FVC ratio <0.7
Modified British Medical Research Council questionnaire
CXR - hyperexpanded chest, hyperlucent, flattened diaphragm
Bloods - assess the severity
ABG - PaCO2 >50, PaO2 <60
ECG and echo - Assess for cor pulmonale (R ventricular hypertrophy, arrhythmias, ischaemia)
Sputum and blood cultures
Alpha-1 antitrypsin levels
PEFR - rule out asthma
CT chest - hyperinflammation, bullae formation

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9
Q

How FEV1/FVC ratio correlates to severity

A

Mild: >80% predicted
Moderate: 50-80% predicted
Severe: 30-50% predicted
Very severe: <30% predicted

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10
Q

Features of an acute exacerbation of COPD

A
Worsening breathlessness with increased sputum volume and purulence
Cough 
Wheeze
Fever 
URTI in past 5 days
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11
Q

Admission criteria for COPD

A

Severe breathlessness
Inability to cope at home
Rapid onset of symptoms
Acute confusion or impaired consciousness
Cyanosis
SpO2 <90
Worsening peripheral oedema or new arrhythmia

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12
Q

Management for an acute exacerbation

A
  1. ABCDE
  2. 24% oxygen through venturi mask
  3. Salbutamol nebs 5mg AND ipratropium nebs 0.5mg
  4. Oral prednisolone 30mg
  5. Severe - ABx e.g. amoxicillin, co-amoxiclav
  6. NO response -> theophylline IV
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13
Q

Management for an acute exacerbation with decompensated T2RF

A
  1. ABCDE
  2. Refer to ITU
  3. Aim oxygen 98%
  4. salbutamol nebs 5mg and ipratropium nebs 0.5mg
  5. oral prednisolone 30mg
  6. CPAP or BiPAP
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14
Q

Conservative management for chronic COPD

A

STOP smoking
influenza and pneumococcal vaccines
Pulmonary rehab (aerobic exercise, strength training)
Breathing and chest physio

± mucolytics e.g. carbocysteine
± long-term oxygen therapy (LTOT) if PaO2 <7.3 despite maximal treatment | PaO2 7.3-8.0 + pulmonary HTN, peripheral oedema, polycythaemia, nocturnal hypoxia | terminally ill
± home news
± BiPAP

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15
Q

Medical management for chronic COPD

A
  1. SABA or SAMA
  2. No asthmatic features - LABA or LAMA
  3. Asthmatic features - LABA + ICS
  4. LABA + LAMA + ICS

Long term oxygen, lung volume reduction surgery

Asthmatic/steroid-responsive:
Any previous diagnosis of asthma or atopy 
Higher eosinophil count 
Substantial variation in FEV1 over time 
Substantial diurnal variation in PEFR
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16
Q
Give examples of the following: 
SABA 
SAMA 
LABA 
LAMA 
ICS 
Oral CS
LABA + ICS
A
SABA: Salbutamol 0.1mg 
SAMA: 
LABA: Formoterol
LAMA: 
ICS: beclemetasone, budesonide
Oral CS: prednisolone
LABA + ICS: symbicort, foster,  seretide
17
Q

Complications of COPD

A
Cor pulmonale 
Lung cancer
Recurrent pneumonia (esp. strep pneumoniae, influenza
Depression
Pneumothorax (bullae rupture)
Anaemia
Resp. failure 
Polycythaemia
18
Q

Prognosis for COPD

A

Primarily influenced by severity and presence of co-morbs
Smoking cessation and oxygen supplementation are the only 2 factors that improve survival rate
High level of morbidity