FN: COPD Flashcards
Definition
Airway obstruction
Chronic bronchitis
Emphysema
Airway obstruction
FEV1 <0.70
Chronic bronchitis
cough and sputum production on most days for 3 months of 2 successive years
Emphysema:
histological diagnosis of enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls.
Causes
- Smoking
- Pollution
- Alpha1ATD – young age COPD + FH
Symptoms
- Cough + sputum
- Dyspnoea
- Wheeze
- Wt. loss
Signs
• Tachypnoea • Prolonged expiratory phase • Hyperinflation → Reduced cricosternal distance → Loss of cardiac dullness → Displaced liver edge • Wheeze • May have early-inspiratory crackles • Cyanosis • Cor pulmonale: raised JVP, oedema, loud P2 • Signs of steroid use
Pink Puffers
Emphysema • Raised alveolar ventilation → breathless but no cyanosed • Normal or near normal PaO2 • Normal of low PaCO2 • Progress → T1 respiratory failure
Blue Bloaters
Chronic Bronchitis
• Reduced alveolar ventilation → cyanosed but not breathlessness
• Reduced PaO2 and raised PaCO2: rely on hypoxic drive
• Progress → T2 respiratory failure and cor pulmonale
Complications
Acute exacerbations ±infection Polycythaemia Pneumothorax (reuptured bullae) Cor pulmonale Lung carcinoma
Treatments →
General
Mucolytic:
Breathlessness and/or exercise limitation
Exacerbations or persistent breathlessness
Persistent exacerbations or breathlessness
LTOT (long term oxygen therapy)
Surgery
General
- Stop smoking
a. Specialist nurse
b. Nicotine replacement therapy
c. Bupoprion, varenicline (partial nicotineagonist)
d. Support programme - Pulmonary rehab
- Treat poor nutrition and obesity
- Manage comorbidities e.g. cardiovasc, lung cancer, osteoporosis
- Influenza and pneumococcal vaccine
Mucolytic:
Carbocisteine
Breathlessness and/or exercise limitation
- SABA and/or SAMA (ipratropium) PRN
* SABA PRN may continue at all stages
Exacerbations or persistent breathlessness
- FEV >50% LABA or LAMA (tiptropium)
* FEV1<50% LABA + ICS combo or LAMA
