COPD Flashcards
1
Q
What is COPD?
A
- Progressive disorder characterised by airway obstruction with no reversibility
2
Q
What is the difference between COPD and asthma?
A
- Asthma is reversible with bronchodilator whereas COPD is not
3
Q
Chronic bronchitis is defined clinically as?
A
- chronic productive cough for 3 months over 2 consecutive years
- Sx improve if stop smoking
4
Q
Emphysema is defined histologically as?
A
- enlarged air spaces distal to terminal bronchioles
- destruction of alveolar walls and no fibrosis on CT
5
Q
What are the differentials for COPD?
How do you differentiate COPD from them?
A
- Lung cancer
- Fibrosis
- HF
- COPD does not cause clubbing
- rarely haemoptysis or chest pain
6
Q
What are the RF for COPD?
A
- >35 years
- smoking (passive, active)
- pollution related
- a-1-antitrypsin deficiency
- occupational exposure - coal mining
7
Q
What are the sx of COPD?
A
- chronic cough - usually productive
- sputum production
- SOB on exertion
- frequent bronchitis
- wheeze
8
Q
What are the signs of COPD?
A
- General
- Tachypnoea
- use of accessory muscles
- hyperinflation
- cyanosis
- cor pumonale
- Palpation
- dec. cricosternal angle
- dec. expansion
- hyperresonant precussion
- Auscultation
- quiet breath sounds
- wheeze
9
Q
What concerning features will prompt you to think of an alternative diagnosis?
A
- weight loss
- hemoptysis
- anorexia
- chest pain
- lymphadenopathy
- finger clubbing
- unexplained fatigue
10
Q
What are the Cx of COPD?
A
- Acute exacerbations +/- infection
- Respiratory failure T2
- Cor pulmonale
- pneumothorax
- lung cancer
- polycythaemia
11
Q
What scale would you use to assess the impact of their breathlessness?
A
Medical Research Council (MRC) Dyspnea Sclae
12
Q
Describe the MRC Dyspnea scale
*grades 1-5
A
- Grade 1 – Breathless on strenuous exercise
- Grade 2 – Breathless on walking up hill
- Grade 3 – Breathless that slows walking on the flat
- Grade 4 – Stop to catch their breath after walking 100 meters on the flat
- Grade 5 – Unable to leave the house due to breathlessness
13
Q
How would you diagnose COPD?
A
- Clinical presentation
- Spirometry
- Obstructive
14
Q
Describe the grading of severity of airflow obstruction
*think 4 stages
A
- Stage 1: FEV1 80% or more of predicted (mild)
- Stage 2: FEV1 50-79% of predicted (moderate)
- Stage 3: FEV1 30-49% of predicted (severe)
- Stage 4: FEV1 <30% of predicted (very severe)
15
Q
What Ix would you perform for COPD?
A
- Bedside
- Spirometry - obstructive pattern
- ECG - R A/V hypertrophy, due to cor pulmonale
- BMI
- sputum culture - assess chronic infection
- Bloods
- FBC - polycythaemia
- ABG - low PaO2/ high PaCO2
- Alpha-1 antitrypsin level
- Imaging
- CXR
- CT - assess fibrosis, cancer, bronchiectasis
16
Q
What CXR features will you see in COPD?
A
- Hyperexpanded
- Flat hemidiaphragms
- Hypodense
- Large central pulmonary arteries
- Bullae +/-
- cardiomegaly
- sabre-sheath trachea (coronal narrowing with sagittal widening)
17
Q
A
18
Q
What CT features will you see in COPD?
A
- Bronchial wall thickening
- Scarring
- Airspace enlargement
19
Q
What are the two tools used to assess severity of COPD?
A
- BODE index (body mass index, airflow obstruction, Dyspnoea, Exercise capacity)
- GOLD (global initiative for COPD)
20
Q
What is the BODE index used for?
A
- predict outcome and number and severity of exacerbations
21
Q
What is the GOLD tool used for?
A
- Categorizes severity of COPD into 4 stages absed on post-bronchodilator FEV1%
- Not useful in predicting total mortality for 3 years
22
Q
What are the conservative mx for COPD?
A
- Smokig cessation
- Pneumococcal and anual flu vaccine
- education - check inhaler techniique
- pulmonary rehab
- self mx plan - acute excacerbation
23
Q
How would you Mx chronic stable COPD?
* stepwise mx
A
First step
- SABA or SAMA, PRN
Second step (Ongoing symptoms despite SABA/SAMA or acute exacerbations)
- LABA+LAMA if no evidence of steroid responsiveness or asthmatic features), OR
- LABA+ICS if evidence of steroid responsiveness or asthmatic features
Third step: offer escalation to triple therapy (LABA + LAMA + ICS)
- Option 1 (already on LABA + LAMA): 3 month trial of triple therapy if clinical features impact quality of life. If no improvement, revert back to LABA + LAMA only
- Option 2 (already on LABA + LAMA): offer triple therapy if 1 severe or 2 moderate acute exacerbations within one year.
- Option 3 (already on LABA + ICS): offer triple therapy if clinical features impact quality of life or 1 severe or 2 moderate acute exacerbations within one year
24
Q
What are the different types of delivery devices?
A
- metered dose inhalers (MDI)
- dry powder inhaler (DPI)
- soft mist inhaler (SMI)
- Spacers
- nebuliser
25
What is the pathophysiology of COPD?
* Small airway disease
* airway inflammation
* airwat fibrosis, luminal plugs
* Inc. airway resistance
* Parenchymal destruction
* loss of alveolar attachments
* decrease elastic recoil
26
Name an abx used for prophylaxis in COPD?
* Azithromycin
27
What are the criterias to consider Azithromycin in COPD?
* Pt dont smoke
* Optimised medication and inhalers
* Vaccinated
* Have been reffered to pulmonary rehabilitation
* Experience frequent excacerbation c putum production
28
What is the dose for Azithromycin?
* 250mg 3tw
29
What is the pathophysiology of COPD?
**Chronic bronchitis**
* Goblet cell hyperplasia
* mucus hypersecretion
* Chronic inflammation and fibrosis
* Narrowing of small airways
**Alveoli**
* alveoli collapse
* bullae formation
Cor pulmonale
* Chronic hypoxia \> pulmonary vasoconstriction \> increase pulmonary arterial pressure \> R sided heart failure
* Inc JVP, cyanosis, ankle oedema, parasternal heave, hepatomegaly
30
In primary care, when would you refer COPD pt to clinician?
* Diagnostic uncertainty
* Severe COPD (FEV1 \< 50%)
* Cor pulmonale
* Assessment for specialist therapy (i.e. long-term oxygen therapy or nebuliser therapy)
* Bullous disease
* Rapid decline in FEV1
* Assessment for surgical intervention (i.e. lung reduction surgery, transplantation)
* Assessment for pulmonary rehabilitation
31
What are the indications for long term oxygen therapy (LTOT)?
* Arterial Pa02 \< 7.3 kPa, OR
* Arterial Pa02 \< 8 kPa with any of:
* Pulmonary hypertension
* Peripheral oedema
* Secondary polycythaemia
\*pt require 15hrs/day for benefit
32
What are the Cx of COPD?
* Exacerbated COPD
* T2RF
* Pneumonia
* Pheumothorax
* Polycythaemia vera
* Depression
33
What surgical options are available for COPD?
* lung reduction surgery
* bullectomy
* lung transplantation
34
What is the most effective way to stop decrease of FEV1 in COPD?
* Smoking cessation
35
When will you offer Pt LTOT in COPD?
* pO2 of \< 7.3 kPa or
* pO2 of 7.3 - 8 kPa and
* secondary polycythaemia
peripheral oedema
pulmonary hypertension
36
37
What factors may improve survival in patients with stable COPD?
* smoking cessation - the single most important intervention in patients who are still smoking
* long term oxygen therapy in patients who fit criteria
* lung volume reduction surgery in selected patients
38
What advices would you give for pt needing LTOT?
* Pt should be on suplemental O2 for min 15hrs/day
* Warn about risk of fire explosion if they smoke or someone around them smoke
* Offer smoking cessation
* Use oxygen concentrators to provide fixed supply of O2 at home
39
What is the reasoning for LTOT in COPD?
1. Pt c COPD have polycythaemia
2. Polycythaemia increases blood viscosity \> increases resistance to flow
3. High risk of thrombosis
