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COPD and exacerbations Flashcards

1
Q

Define COPD.

A

Progressive, non reversible obstructive pulmonary disease

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2
Q

What are the 2 diseases associated with COPD?Give definitions of each.

A

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)

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3
Q

What are the presenting features of COPD?

A

Productive coughSOBProgressive dyspnoea on exertionWheezingHx smoking

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4
Q

What are the main features of the Px?

A

NB: Px is generally a poor indicator unless in COPD exacerbationCyanosisIncrease JVP (if CHF)Barrel chest due to air trappingHyperresonanceProlonged expiration

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5
Q

What lung function test value is indicative of COPD?

A

FEV1/FVC

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6
Q

What are the DDx of COPD?

A

a. Asthma: COPD is not reversible by bronchodilatorb. a-1 anti-trypsin deficiency: always think of this if patient is not a chronic smoker,

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7
Q

What Ix should take place in Dx COPD?

A

Lung function testsABGsCXRECG

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8
Q

How do we manage COPD?

A

Increase survival rate:1. Smoking cessation * most important (legal requirement to advise on medical notes)2. Supplemental home O2 therapy (

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9
Q

What are the three things that should not be administered to a patient with COPD?

A

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

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10
Q

What should you admit a patient with COPD?

A
  1. Worsening saturation (
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11
Q

Define COPD exacerbation.

A

= acute worsening of Sx brought on by infection, CHF, air pollution, idiopathic factor

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12
Q

What are the DDx of COPD exacerbation?

A

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

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13
Q

How should you manage a pt with COPD exacerbation?

A

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

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14
Q

If O2 cannot be maintained at 90% during management what are the options for O2 delivery?

A

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

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15
Q

What are the symptoms of prolonged corticosteroid use?

A

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

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16
Q

What are the signs of prolonged corticosteroid use?

A

*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

17
Q

Define COPD.

A

Progressive, irreversible obstructive pulmonary disease

18
Q

Clinical Features of COPD

A

Productive coughDyspnoeaDecreased exercise toleranceWheezing

19
Q

Signs of COPD

A

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

20
Q

DDx of COPD

A

a. Asthma: COPD is not reversible by bronchodilatorb.

21
Q

Ix and results of COPD

A

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

22
Q

Management of COPD

A

Increase survival rate:1. Smoking cessation * most important (legal requirement to advise on medical notes)2. Supplemental home O2 therapy (

23
Q

What are the signs of prolonged corticosteroid use?

A

*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

24
Q

Aetiology of COPD

A

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

25
Q

Dx of COPD

A

Diagnosis is based on Hx of smoking and progressive dyspnoea, with evidence of irreversible airflow obstruction on spirometry

26
Q

What lung function test value is indicative of COPD?

A

FEV1/FVC

27
Q

DDx of COPD (4)

A

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

28
Q

Management of COPD

A

Increase survival rate:1. Smoking cessation * most important (legal requirement to advise on medical notes)2. Supplemental home O2 therapy (

29
Q

Define acute COPD exacerbation

A

= acute worsening of baseline Sx

30
Q

DDx of COPD exacerbation?

A

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

31
Q

Management of COPD exacerbation

A

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

32
Q

Dx of COPD

A

Diagnosis is based on Hx of smoking and progressive dyspnoea, with evidence of irreversible airflow obstruction on spirometry

33
Q

Aetiology of COPD exacerbation

A
  • Viral: rhinovirus, influenza, RSV, coronavirus, adenovirus* Bacterial: - Most common: 1. Haemophilus influezae, 2. Streptococcus pneumoniae, 3. Moraxella catarrhalis - Atypical: Mycoplasma, Chlamydia pneumoniae* Air pollution
34
Q

Symptoms of COPD exacerbation

A

Increased sputum volume and/or purulence, increasing dyspnoea or wheeze, chest tightness, fluid retention

35
Q

Ix of COPD exacerbation

A

CXRABGsECGFBCU&Es* admission arterial pH is the best predictor of survival (pH

36
Q

Management of COPD exacerbation

A

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

37
Q

Ix of COPD exacerbation

A

CXRABGsECGFBCU&Es* admission arterial pH is the best predictor of survival (pH

38
Q

In the management of COPD exacerbation what are the consequences of not maintaining O2 saturation between 80-90%?

A

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

39
Q

In the management of COPD exacerbation what are the consequences of not maintaining O2 saturation between 80-90%?

A

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

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