COPD with Emphysema case Flashcards

1
Q

What are the key features in the history that would suggest COPD exacerbation

What are the other signs and symptoms

A

Productive cough, white sputum
SOB

Barrel chest, hyperresonance
Poor air movement
Reduced chest expansion
Accessory muscle use
Cyanosis
Cor pulmonale
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What would spirometry and peak flow show before and after BD

-use the algorithm

A

Peak flow
-low, limited reversibility

FEV1, FVC, FER
-low, limited reversibility, obstructive pattern

TLC, RV
-increased, some decrease => symptomatic relief

TLCO, KCO
-Low => diffusion membrane SA lost in emphysema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What results could you get from the ABG

How would you be able to tell if someone is on air/on O2 from the ABG

A

Hypoxemia
Hypercapnia due to CO2 retention

If CO2 retention is chronic, bicarbonate will be raised
too

High PO2 and PCO2 with a sum of over 20kPa => on O2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What examinations would you order and why

A

Resp

  • Barrel chest, hyper resonance
  • Poor air movement
  • equal but reduced chest expansion <= hyperinflation
  • wheeze, crackles may also be heard
  • use of accessory muscles
  • cyanosed

CV

  • rule out CV causes
  • difficulty locating apex beat <= hyperinflation
  • establish cardiac strain

GI
-rule out other pathologies

MSK
-rule out MSK pathologies

Urinalysis
-rule out infection, kidney issues

Reticulendothelial
-rule out malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What investigations would you order and why

A

FBC, electrolytes, U&E

  • establish severity of exacerbation
  • anaemia, polycythemia
  • high WBC => infection
  • hypokalaemia => SE of salbutamol
  • high urea, hyponatremia => pneumonia?

CXR
-rule out other causes

ECG
-rule exclude comorbidities

MCS
-identify cause of purulent sputum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How would you manage this case?

What are the signs of deterioration?
What would you do in this scenario?

When would you consider invasive ventilation?

A

SABA, SAMA (nebulised with air if CO2 retainer
ICS (prednisolone or hydrocortisone)
O2 (lower sats for CO2 retainers)
Abx if there is evidence of infection (doxycycline, amoxicillin, clarythromycin)

Type 2 resp failure despite treatment => NIV

NIV not successful/tolerated
Reduced consciousness
Arrested
Haemodynamic instability/arrythmias
Cannot maintain airway
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

If there is a family history of COPD, what would you suspect?
How does this alternative cause result in COPD
What are these groups predisposed to?

A

Alpha1-antitrypsin deficiency

  • autosomal codominant
  • alpha1-antitrypsin protects against proteases (eg neutrophil elastase), preventing alveolar destruction

-normally produced in the liver but cannot be released => alveolar damage, accumulation in liver => hepatocyte destruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How would you differentiate between COPD and asthma from the history

  • smoker status?
  • under 35
  • chronic productive cough
  • SOB patterns
  • night time waking with SOB, wheeze
  • significant diurnal symptom variability
A

COPD

  • most are current/ex smokers
  • rare in under 35
  • common to have a productive cough
  • uncommon night time waking with SOB, wheeze
  • uncommon to have variability in symptoms
  • SOB, persistent, progressive

Asthma

  • possible current/ex smoker
  • often under 35
  • uncommon to have a productive cough
  • common night time waking with SOB, wheeze
  • common to have significant variation in symptoms
  • SOB, variable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What measures could you use to grade the severity of obstructive airflow
What measures could you use to grade the severity of her breathlessness?

A

Obstructive flow, GOLD in patients with FER < 0.7

  • GOLD I (mild) FEV1 > 80%
  • GOLD II (moderate) FEV1 50-79
  • GOLD III (severe) FEV1 30-49
  • GOLD IV (very severe) FEV1 under 30

MMRC Dyspnoea Scale

  • 0, strenuous exercise only
  • 1, hurrying, walking on an incline
  • 2, walks slower than people of the same age due to SOB/stops due to SOB on level plane
  • 3, stops for breath after 100m/few mins on level plane
  • 4, too breathers to leave house/SOB when dressing, undressing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How would you manage COPD in the long term

A

Smoking cessation
Flu, pneumococcal vaccinations
Pulmonary rehab
SABA, SAMA

Long term O2 therapy
Prophylactic ABx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly