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Respiratory Medicine > COPD > Flashcards

COPD Flashcards

1
Q

What is COPD?

A
  • Airway obstruction which is progressive and not fully reversible.
  • It includes chronic bronchitis and emphysema
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2
Q

What is the predominant cause of COPD?

A

Smoking

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3
Q

What is an endogenous cause of COPD? How does it cause the disease?

A

Alpha-1-antitrypsin deficiency - This is a protease inhibitor which suppresses enzymes which breaks down proteins. It presents with panacinar emphysema and cirrhosis.

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4
Q

What are some other causes of COPD?

A

Endogenous - IgA deficiency, primary ciliary dyskinesis

Exogenous - Air pollution, illicit drug use, recurrent pulmonary infections, TB, chronic exposure to dust

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5
Q

What is the pathophysiology of COPD?

A
  1. Chronic inflammation - Increased neutrophils, macrophages and T lymphocytes. This results in:
    - Goblet cell proliferation, mucus hypersecretion, impaired ciliary function
    - Fibrosis
    - Smooth muscle hyperplasia of small airways and pulmonary vasculature, leading to pulmonary hypertension
  2. Parenchymal dysfunction
    - Destruction of alveolar walls and elastic tissue
    - Decreased elastic recoil and increased compliance
    - Air trapping and hyperinflation
  3. Imbalance of oxidants/anti-oxidants and overabundance of free radicals
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6
Q

How is the airway obstructed in COPD?

A
  1. Luminal obstruction by secretions
  2. Narrowing of small bronchioles as less radial traction by elastin in the surrounding alveoli
  3. Less elastic recoil so air trapping
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7
Q

What is a ‘pink puffer’?

A
  • A typical COPD patient, who has increased alveolar ventilation, a near normal pO2 and normal/low pCO2. - They are breathless but not cyanosed.
  • They will likely progress to type I respiratory failure
  • Emphysema end of the COPD spectrum
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8
Q

What is a ‘blue bloater’?

A
  • A typical COPD patient, who has decreased alveolar ventilation and a low pO2 and a high pCO2.
  • They are cyanosed but not breathless and may go on to develop cor pulmonale.
  • Their respiratory centres are relatively insensitive to CO2 and rely on hypoxic drive to maintain respiratory oxygen.
  • Chronic bronchitis end of the COPD spectrum
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9
Q

What are some symptoms of COPD?

A

Cough
Sputum
Wheeze
Dyspnoea - Initially worse on exercise and then progresses over time

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10
Q

What are some signs of COPD?

A 
Tachypnoea
Use of accessory muscles of respiration
Hyperinflation
Decreased cricosternal distance (<3cm)
Reduced chest expansion
Resonant or hyperresonant percussion
Quiet breath sounds 
Wheeze
Cyanosis 
Cor pulmonale
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11
Q

How do you investigate for COPD?

A
  1. Bloods - Increased PCV as erythrocytosis secondary to chronic hypoxia
  2. CXR
  3. CT
  4. ECG
  5. aBG
  6. Spirometry
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12
Q

What would a CXR show in COPD?

A
  • Hyperinflation
  • Flat hemidiaphragms
  • Large central pulmonary arteries
  • Decreased peripheral vascular markings
  • Bullae
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13
Q

What would a CT show in COPD?

A
  • Bronchial wall thickening
  • Scarring
  • Air space enlargement
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14
Q

What would an ECG show in advanced COPD?

A

Right atrial and venticular hypertrophy (cor pulmonale)

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15
Q

What would an aBG show in COPD?

A

Decreased pO2 and hypercapnia

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16
Q

What would spirometry show in COPD?

A
  • An obstructive pattern and air trapping
    FEV1<80% of predicted, FEV1:FVC ratio <70%
    Increased TLC, increased RV, decreased DLCO
17
Q

What are some lifestyle changes you can implement for patients with COPD?

A 
Smoking cessation
Encourage exercise
Correct BMI with diet advice and supplements 
Screen for depression
Flu and pneumococcal vaccines
18
Q

How might a patient present with an acute exacerbation of COPD?

A

Increasing cough, breathlessness, wheeze, decreased exercise capacity

19
Q

What investigations should be done in acute exacerbation of COPD?

A

Bloods - aBG, FBC, U+E, CRP, blood cultures if pyrexic
CXR - Exclude pneumothorax and infection
ECG
Send sputum for culture if purulent

20
Q

What is the treatment for acute exacerbation of COPD?

A
  1. O2 via a fixed performance face mask due to risk of CO2 retention. Aim for sats 88-92%. Start at 24-28% O2. Adjust according to aBG.
  2. Nebulised salbutamol 5mg/4hr and ipratropium 500micrograms/6hr
  3. Steroids - Oral prednisolone 30mg START, then OD for 7 days. IV 200mg hydrocortisone if cant do PO.
  4. Antibiotics - If evidence of infection. Amoxicillin 500mg/8hr PO.
  5. Physiotherapy to aid sputum expectoration.
21
Q

What should be added if there is no initial response to the treatment of acute exacerbation of COPD?

A

IV aminophylline

22
Q

If there is no response after adding aminophylline, what do you do to treat acute exacerbation of COPD?

A
  1. Consider NIV if type 2 resp failure and pH 7.25-7.35
  2. Consider a respiratory stimulant drug eg doxapram if unsuitable for ventilation.
  3. If pH<7.25 - consider ITU referral

Respiratory Medicine (14 decks)

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