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*3a. Respiratory > Obstructive lung disease: COPD (R1) > Flashcards

Obstructive lung disease: COPD (R1) Flashcards

1
Q

Defining COPD
- COPD comprises of which 2 diseases?
- How are these diseases defined?
- Do these two diseases almost always coexist? Why?

A

Emphysema: defined by structural change
Chronic bronchitis: defined by clinical features

Yes - due to their shared number 1 risk factor: smoking.

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2
Q

Defining COPD
- COPD is an obstructive lung disease. What accounts for this obstruction in a) emphysema and b) chronic bronchitis?
- Both asthma and COPD have a reduced FEV1/FVC. What is the main difference between them?

A

Emphysema: ariway collapse
Bronchitis: mucus

Unlike asthma, the obstruction is not fully reversible by bronchodilators

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3
Q

Explain COPD to a patient

A
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4
Q

Risk factors
- Shared risk factor?
- 1 risk factor for emphysema + chronic bronchitis?

A

Smoking

Emphysema: alpha 1 antitrypsin deficiency
Chronic bronchitis: exposure to air pollutants (dust, silica)

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5
Q

History: symptoms?

A

Dyspnoea
- Pursed lip breathing + use of accessory muscles
- Worse on exertion
- Worse lying down
Cough + sputum
Cyanosis
Fatigue + weight loss

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6
Q

History:
- Difference in these symptoms for emphysema vs bronchitis?

A
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7
Q

Exam
- General inspection?

A

Cyanosis
Pursed lip breathing
Use of accessory muscles to breathe

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8
Q

Exam
- Vital signs?

A

Increased RR, HR, BP
SpO2: aim for 88-92%

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9
Q

Exam
- Arms?

A

Tar staining
Clubbing
Muscle wasting
Asterixis/flapping tremor (CO2 retention)

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10
Q

Exam
- Face

A

Cheeks: may be flushed (emphysema) or cyanosed (bronchitis)
Tongue: central cyanosis

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11
Q

Exam
- Neck

A

Distended JVP - if right heart failure
Tracheal tub - low diaphragm

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12
Q

Exam
- Chest?

A

Barrell chest
Hoover’s sign

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13
Q

Exam
- Describe Hoover’s sign

A

Air trapping leads to hyperinflatation of chest and stretching of diaphragm tilit is no longer domed.

Contraction pulls the diaphragm inwards instead of down, hence inwards movement of the chest in inspiration

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14
Q

Exam
- Heart?

A

Loud S2 (due to pulmonary hypertension/cor pulmonale) and pansystolic murmur (tricuspid regurgitation) - cor pulmonale

?Right parasternal heave (due to pulmonary hypertension), ?absent apex beat

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15
Q

Exam: lungs
- Chest expansion
- Expiratory phase
- Breath sounds
- Wheeze
- Crackles
- Percussion

A
  • Reduced chest expansion
  • Prolonged expiratory phase
  • Reduced breath sounds
  • Wheeze
  • Coarse crackles
  • Hyper resonant percussion
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16
Q

Exam
- Abdomen

A

Hepatosplenomegaly (if right heart failure)

17
Q

Exam
- Legs

A

Swelling (of right heart failure)

18
Q

Investigations:
- What is the gold standard investigation for COPD?

A

Lung function testing (spirometry)

19
Q

Investigations
- What do lung function tests show?

A

FEV1/FVC < 0.7n
Incomplete response to beta 2 agoinsts (irreversibility)

20
Q

Investigations: what are the ones we should do?

A

Labs
- FBC
- ABG

Imaging
- CXR

Special tests
- Lung function tests

21
Q

Investigations
- What will FBC show?

A

Increased WCC: infective exacerbation
Increased hematocrit: hypoxia and consequent polycythemia
Decreased hemoglobin: anemia of chronic disease

22
Q

Investigations
- What will ABG show?

A

Hypoxia (PaO2 <60mmHg) or hypercapnia (PaCO2 > 50mmHg)

23
Q

Investigations
- What will PA chest xray show?

A

Large hyperlucent lung fields
Flattened diaphragm

24
Q

Investigations
- What will the lateral CXR show?

A
25
Q

Management of acute exacerbations
- Pharmacological management?

A
  • Salbutamol 4-8 puffs: via MDI + spacer; every 3-4 hours as needed
  • Chest infection: antibiotics (as per pneumonia)
  • Oral prednisolone for 5 days
26
Q

Management of acute exacerbations
- Managing oxygen saturations?
- Allied health intervention?

A
27
Q

Ongoing management
- Pharmacologic management: first line?

A
28
Q

Ongoing management
- Pharmacologic management: second line?

A
29
Q

Ongoing management
- Pharmacologic management: third line?

A
30
Q

Ongoing management
- Non pharmacological management: for all stages?

A
31
Q

Ongoing management
- Non pharmacological management: for advanced stages?

A
32
Q

Explain COPD management to a patient?

A

*3a. Respiratory (20 decks)

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