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Respiratory Medicine > COPD > Flashcards

COPD Flashcards

1
Q

What is COPD?

A
  • Progressive disorder characterised by airway obstruction with no reversibility
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2
Q

What is the difference between COPD and asthma?

A
  • Asthma is reversible with bronchodilator whereas COPD is not
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3
Q

Chronic bronchitis is defined clinically as?

A
  • chronic productive cough for 3 months over 2 consecutive years
  • Sx improve if stop smoking
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4
Q

Emphysema is defined histologically as?

A
  • enlarged air spaces distal to terminal bronchioles
  • destruction of alveolar walls and no fibrosis on CT
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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
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6
Q

What are the RF for COPD?

A
  • >35 years
  • smoking (passive, active)
  • pollution related
  • a-1-antitrypsin deficiency
  • occupational exposure - coal mining
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7
Q

What are the sx of COPD?

A
  • chronic cough - usually productive
  • sputum production
  • SOB on exertion
  • frequent bronchitis
  • wheeze
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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
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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
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10
Q

What are the Cx of COPD?

A
  • Acute exacerbations +/- infection
  • Respiratory failure T2
  • Cor pulmonale
  • pneumothorax
  • lung cancer
  • polycythaemia
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11
Q

What scale would you use to assess the impact of their breathlessness?

A

Medical Research Council (MRC) Dyspnea Sclae

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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
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13
Q

How would you diagnose COPD?

A
  • Clinical presentation
  • Spirometry
    • Obstructive
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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)
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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
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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
Q

What is the pathophysiology of COPD?

A
  • Small airway disease
    • airway inflammation
    • airwat fibrosis, luminal plugs
    • Inc. airway resistance
  • Parenchymal destruction
    • loss of alveolar attachments
    • decrease elastic recoil
26
Q

Name an abx used for prophylaxis in COPD?

A
  • Azithromycin
27
Q

What are the criterias to consider Azithromycin in COPD?

A
  • Pt dont smoke
  • Optimised medication and inhalers
  • Vaccinated
  • Have been reffered to pulmonary rehabilitation
  • Experience frequent excacerbation c putum production
28
Q

What is the dose for Azithromycin?

A
  • 250mg 3tw
29
Q

What is the pathophysiology of COPD?

A

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
Q

In primary care, when would you refer COPD pt to clinician?

A
  • 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
Q

What are the indications for long term oxygen therapy (LTOT)?

A
  • 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
Q

What are the Cx of COPD?

A
  • Exacerbated COPD
  • T2RF
  • Pneumonia
  • Pheumothorax
  • Polycythaemia vera
  • Depression
33
Q

What surgical options are available for COPD?

A
  • lung reduction surgery
  • bullectomy
  • lung transplantation
34
Q

What is the most effective way to stop decrease of FEV1 in COPD?

A
  • Smoking cessation
35
Q

When will you offer Pt LTOT in COPD?

A
  • pO2 of < 7.3 kPa or
  • pO2 of 7.3 - 8 kPa and
    • secondary polycythaemia

peripheral oedema

pulmonary hypertension

36
Q
A
37
Q

What factors may improve survival in patients with stable COPD?

A
  • 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
Q

What advices would you give for pt needing LTOT?

A
  • 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
Q

What is the reasoning for LTOT in COPD?

A
  1. Pt c COPD have polycythaemia
  2. Polycythaemia increases blood viscosity > increases resistance to flow
  3. High risk of thrombosis

Respiratory Medicine (12 decks)

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