COPD and exacerbations Flashcards
Define COPD.
Progressive, non reversible obstructive pulmonary disease
What are the 2 diseases associated with COPD?Give definitions of each.
Emphysema: destruction of alveoli, resulting in decrease O2 exchange (pathological Dx but do not usually take biopsy)Chronic bronchitis: excessive production of mucus with daily productive cough of >/= 3 months for 2 consecutive years (clinical Dx)
What are the presenting features of COPD?
Productive coughSOBProgressive dyspnoea on exertionWheezingHx smoking
What are the main features of the Px?
NB: Px is generally a poor indicator unless in COPD exacerbationCyanosisIncrease JVP (if CHF)Barrel chest due to air trappingHyperresonanceProlonged expiration
What lung function test value is indicative of COPD?
FEV1/FVC
What are the DDx of COPD?
a. Asthma: COPD is not reversible by bronchodilatorb. a-1 anti-trypsin deficiency: always think of this if patient is not a chronic smoker,
What Ix should take place in Dx COPD?
Lung function testsABGsCXRECG
How do we manage COPD?
Increase survival rate:1. Smoking cessation * most important (legal requirement to advise on medical notes)2. Supplemental home O2 therapy (
What are the three things that should not be administered to a patient with COPD?
Expectorants (induces cough) or mucolytics - always will have mucus prod’n and will just be replacedCough suppressants - pts need to be able to cough up mucus
What should you admit a patient with COPD?
- Worsening saturation (
Define COPD exacerbation.
= acute worsening of Sx brought on by infection, CHF, air pollution, idiopathic factor
What are the DDx of COPD exacerbation?
a. PE: in PE there is continuous deterioration that is non-responsive to LABA and supplemental O2; prothrombotic RF should also be present *do CT scanb. Pulmonary oedema: CXR displays generalised lung opacity
How should you manage a pt with COPD exacerbation?
To decrease mortality:1. supplemental O2 to maintain >/= 90%To decrease symptoms:2. Inhaled B agonist (increase dose)3. PO corticosteroids (cf. inhaled normally)4. Broad spectrum Abx5. Pulmonary hygiene (suction of airways, physio) to clear mucus+ pneumococcal and flu vaccine
If O2 cannot be maintained at 90% during management what are the options for O2 delivery?
Options for O2 delivery depend on if it is getting to 90% (move down list if not reaching sats):a. Nasal prongs or maskb. Non invasive positive pressure vent (CPAP, BiPAP)c. Mechanical ventilation
What are the symptoms of prolonged corticosteroid use?
Cushing’s syndrome = clinical state produced by chronic glucocorticoid excess (chiefly caused by oral steroids)* Symptoms: - increase weight- mood change: depression, lethargy, irritability, psychosis- proximal weakness (ask them if they have trouble putting out washing, getting up out of chair)- gonadal dysfunction (irregular menses, hirsutism, erectile dysfunction)- acne- recurrent Achilles tendon rupture
What are the signs of prolonged corticosteroid use?
*Signs:- Central obesity- Plethoric - Moon face- Buffalo neck hump- Supraclavicular fat distribution- Skin and muscle atrophy- Bruises- Purple , abdo striae- Osteoporosis- BP increased- Glucose increased - Infection prone- Poor healing
Define COPD.
Progressive, irreversible obstructive pulmonary disease
Clinical Features of COPD
Productive coughDyspnoeaDecreased exercise toleranceWheezing
Signs of COPD
NB: Px is generally a poor indicator unless in COPD exacerbation, depends on severity of underlying disease:- Raised RR- Hyperexanded/barrel chest- Prolonged expiratory time > 5 seconds, with pursed lip breathing- Use of accessory muscles- Quiet breath sounds (esp in lung apices)- Quiet heart sounds (due to overlying hyperinflated lung)- Hyperresonance- Possible basal crepitations- Signs of cor pulmonale and CO2 retention (ankle oedema, raised JVP, warm peripheries, plethoric conjunctivae, bounding pulse, polycythaemia)- CO2 narcosis if Co2 acutely raised
DDx of COPD
a. Asthma: COPD is not reversible by bronchodilatorb.
Ix and results of COPD
A. Lung function tests:- obstructive spirometry and flow-volume loops- reduced FEV1 to 7 posterior ribs seen- Flattened diaphragm - More horizontal ribs- May see bullae, esp at lung apices
Management of COPD
Increase survival rate:1. Smoking cessation * most important (legal requirement to advise on medical notes)2. Supplemental home O2 therapy (
What are the signs of prolonged corticosteroid use?
*Signs:- Central obesity- Plethoric - Moon face- Buffalo neck hump- Supraclavicular fat distribution- Skin and muscle atrophy- Bruises- Purple , abdo striae- Osteoporosis- BP increased- Glucose increased - Infection prone- Poor healing
Aetiology of COPD
a. Smoking: 95% - smoking related (typically > 20 pack years); it occurs in 10-20% of smokersb. a1 - antitrypsin deficiency - AR inherited condition ass with early emphysema; a1-AT is a glycoprotein protease inhibitor produced by liver that opposes neutrophil elastase that destroys alveolar wall tissue
Dx of COPD
Diagnosis is based on Hx of smoking and progressive dyspnoea, with evidence of irreversible airflow obstruction on spirometry
What lung function test value is indicative of COPD?
FEV1/FVC
DDx of COPD (4)
a. Asthma: COPD is not reversible by bronchodilatorb. Congestive heart failure: pt report orthopnoea, & fine bibasilar inspiratory cracklesc. Bronchiectasis: large volume of purulent sputum, Hx recurrent childhood inf, coarse cracklesd. Bronchiolitis: young age, Hx of connective tissue disorder esp RA
Management of COPD
Increase survival rate:1. Smoking cessation * most important (legal requirement to advise on medical notes)2. Supplemental home O2 therapy (
Define acute COPD exacerbation
= acute worsening of baseline Sx
DDx of COPD exacerbation?
a. Congestive heart failureb. Pneumonia: differentiate w/ chest imagingc. Pleural effusiond. PE: in PE there is continuous deterioration that is non-responsive to LABA and supplemental O2; prothrombotic RF should also be present *do CT scane. Pneumothorax
Management of COPD exacerbation
To decrease mortality:1. supplemental O2 to maintain >/= 90%To decrease symptoms:2. Inhaled B agonist (increase dose)3. PO corticosteroids (cf. inhaled normally)4. Broad spectrum Abx5. Pulmonary hygiene (suction of airways, physio) to clear mucus+ pneumococcal and flu vaccine
Dx of COPD
Diagnosis is based on Hx of smoking and progressive dyspnoea, with evidence of irreversible airflow obstruction on spirometry
Aetiology of COPD exacerbation
- Viral: rhinovirus, influenza, RSV, coronavirus, adenovirus* Bacterial: - Most common: 1. Haemophilus influezae, 2. Streptococcus pneumoniae, 3. Moraxella catarrhalis - Atypical: Mycoplasma, Chlamydia pneumoniae* Air pollution
Symptoms of COPD exacerbation
Increased sputum volume and/or purulence, increasing dyspnoea or wheeze, chest tightness, fluid retention
Ix of COPD exacerbation
CXRABGsECGFBCU&Es* admission arterial pH is the best predictor of survival (pH
Management of COPD exacerbation
To decrease mortality:1. 24-35% via face mask supplemental O2 to maintain between 80-90%To decrease symptoms:2. Inhaled B agonist (increase dose)3. PO corticosteroids (cf. inhaled normally)4. Broad spectrum Abx5. Pulmonary hygiene (suction of airways, physio) to clear mucus
Ix of COPD exacerbation
CXRABGsECGFBCU&Es* admission arterial pH is the best predictor of survival (pH
In the management of COPD exacerbation what are the consequences of not maintaining O2 saturation between 80-90%?
Prescribe O2 to maintain saturation between 80-90%, balancing hypoxia, hypercapnia and pH.Too little O2 (SaO2 90% can cause hypercapnia and respiratory acidosis(recall
In the management of COPD exacerbation what are the consequences of not maintaining O2 saturation between 80-90%?
Prescribe O2 to maintain saturation between 80-90%, balancing hypoxia, hypercapnia and pH.Too little O2 (SaO2 90% can cause hypercapnia and respiratory acidosis(recall
