COPD Flashcards
what is COPD?
- preventable and treatable disease characterised persistent, progressive airflow limitation (not fully reversible)
- enhanced chronic inflammatory response in the lungs to noxious gases/particles
what happens with large airways inflammation?
airways narrowing due to chronic irritation of the bronchi causing inflammation and changes to the mucociliary escalator often results in a chronic cough
what happens with the small airways?
airways narrowing due to bronchoconstriction and inflammation; duration and severity are risk factors for development or airway remodelling and COPD
what happens with emphysema?
airways collapse due to destruction of alveolar walls - may lead to bullae
what happens to the airways with COPD?
- chronic inflammation
- increased number of goblet cells
- mucus hyperplasia
- fibrosis
- narrowing and reduction in the number of small airways
- airway collapse due to alveolar wall destruction in emphysema
what are the symptoms for chronic bronchitis (large airways)?
- chronic productive cough for 3 months in 2 successive years
- exclude other causes of chronic cough
what are the symptoms of emphysema (alveolar)?
- abnormal and permanent enlargement of the airspace due to destruction of the alveolar airspace walls
- effects gas exchange
what are the symptoms of small airways disease?
wheeze
what are the risk factors of COPD?
- cigarette smoke
- occupational dust and chemicals
- environmental tobacco smoke (ETS)
- indoor and outdoor air pollution
- genes
- infections
- socio-economic status
- ageing population
what smoking history do you need to take?
- age started
- calculate pack-year history
- times stopped and why failed quit attempt
- recreational drugs smoked (or other substances)
how do you diagnose COPD?
symptoms + risk factors + spirometry
what is the impact of grade 1 COPD?
not troubled by breathlessness except on vigorous exertion
what is the impact of grade 2 COPD?
short of breath when hurrying or walking up inclines
what is the impact of grade 3 COPD?
walks slower than contemporaries because of breathlessness or has to stop for breath when walking at own pace
what is the impact of grade 4 COPD?
stops for breath after walking about 100m or stops after a few minutes walking on the level
what is the impact of grade 5 COPD?
too breathless to leave the house or breathless on dressing or undressing
what are the physical signs of COPD?
- barrel shaped chest
- hyperresonant percussion
- accessory muscles
- prolonged expiration
- pursed-lip breathing
- tripod position
- low BMI
- nicotine staining
what are the physiological effects of COPD?
- increased work of breathing
- reduced exercise tolerance
- impaired gas exchange: hypoxia, hypercapnia, raised pulmonary artery pressure, RV dilatation, cor pulmonale
- loss of fat-free mass
how do you manage chronic COPD?
- stop smoking
- if symptomatic LABA/LAMA combined inhaler
- lots of inhalers
- flu vaccination
- educate and empower
- treat exacerbations
- pulmonary rehabilitation
- think about the whole patient (bones, nutrition, mental health)
- LTOT
what happens with pulmonary rehabilitation?
- 2x supervised sessions for 6 weeks
- supervised exercise
- education
- psychosocial support/group work
what are the other possible treatments for COPD?
- theophylline (oral phosphodiesterase inhibitor)
- azithromycin 3x a week (anti-inflammatory antibiotic prophylaxi)
- lung volume reduction surgery
- lung transplantation
what is acute exacerbation?
acute deterioration in symptoms requiring additional therapy
- mild (SABA)
- moderate (SABA +/- steroids +/- antibiotics)
- severe (hospital admission) or ED attendance
what happens with severe exacerbation of COPD?
ED attendance due to progressive dyspnoea/hypoxia or signs of infection or signs of right heart failure
- antibiotics in signs of infection
- oral steroids
- target saturation 88-92%
- nebulisers
- consider diruetics
- nicotine replacement therapy/refer for smoking cessation
why do you use non-invasive ventilation for COPD?
decompensated hypercapnic respiratory failure despite controlled oxygen and nebuliser treatments
why do you consider invasive mechanical ventilation for COPD?
respiratory failure despite nebulised therapy and controlled oxygen and patient unable to tolerate NIV
when do you palliate for COPD?
respiratory ventilation on background of significant progressive decline over several months/years with no evidence of reversible event
how do you control the symptoms of COPD?
- oromorph
- lorazepam
- fan therapy
- oxygen therapy
- CBT
- pacing/breathing strategies
- hospice input
