Resp COPD Flashcards
What is the definition of COPD?
Fixed airflow obstruction with minimal / no reversibility with bronchodilators
What are the risk factors for COPD?
Smoking
Occupation or environmental risk factors
Personal / family history of lung disease
Briefly describe the pathophysiology of COPD
Mucous gland hyperplasia
Chronic inflammation and fibrosis of small airways
Emphysema due to alveolar wall destruction
Thickened pulmonary arteriolar wall and remodelling
What is the consequence of mucous gland hyperplasia in COPD?
Chronic productive cough
What is the consequence of emphysema?
Irreversible enlargement of airspaces distal to terminal bronchiole leading to loss of elastic recoil and hyper inflated lungs
What is the consequence of thickened pulmonary arteriolar wall remodelling?
Increased pulmonary vascular resistance
Pulmonary hypertension
Impaired gas exchange
What are the clinical features of COPD?
Dyspnoea
Chronic cough
Decreased exercise tolerance
Wheeze
What are the signs of COPD?
Increased respiratory rate Hyperinflated / barrel chest Prolonged expiratory time with pursed lip breathing Use of accessory muscles Quiet breath sounds with/out wheeze Quiet heart sounds Signs of cor pulmonale Signs of CO2 retention
What investigations should be done in COPD?
Spirometry
Chest X ray
What spirometry results would suggest COPD?
FEV1 <80% of predicted or FEV1>80% of predicted with other respiratory symptoms
FEV1/FVC <0.7 after bronchodilation
Raised total lung volume, FRC and RV due to emphysema, air trapping and loss of elastic recoil
What would you expect to see on a CXR in COPD?
Hyperinflated lung fields with attenuation of peripheral vasculature
Flattened diaphragm
What are the differentials of COPD?
Asthma Congestive heart failure Bronchiectasis TB Bronchiolitis Upper airway dysfunction Chronic sinusitis Gastric oesophageal reflux disease Lung cancer
What is the non-pharmacological management of COPD?
Smoking advice
Vaccination - pneumococcal and influenza
Pulmonary rehabilitation
Diet
What is the 1st line pharmacological treatment for mild-moderate COPD?
Short-acting beta 2 agonist e.g. salbutamol
What is the 2nd line pharmacological treatment for mild-moderate COPD?
SABA + long acting antimuscarinic such as braitus zonda inhaler
What is the 3rd line pharmacological treatment for mild-moderate COPD?
SABA + LAMA/long-acting beta2 agonist e.g. spiolto respimat
What is the 1st line pharmacological treatment for severe COPD?
SABA + LAMA
What is the 2nd line pharmacological treatment for severe COPD?
SABA + LAMA/LABA or LABA/ICS such as fostair
Give an example of a mucolytic
Carbocysteine
What should be included in a rescue pack to manage exacerbations?
Short acting bronchodilator
Oral corticosteroid e.g. prednisolone
Oral antibiotics e.g. amoxicillin or doxycycline
Describe grade 0 on the MRC dyspnoea scale
No breathlessness except with strenuous activity
Describe grade 1 on the MRC dyspnoea scale
Breathless hurrying on level or walking up a slight hill
Describe grade 2 on the MRC dyspnoea scale
Has to walk slower than others on level ground due to breathlessness
Describe grade 3 on the MRC dyspnoea scale
Stops for breath after few minutes on level ground
Describe grade 4 on the MRC dyspnoea scale
Too breathless to leave house, breathless with dressing
What are the infectious causes of COPD exacerbations?
Bacterial: haemophilus influenzae, streptococcus pneumoniae, Moraxella catarrhalis
Viral: rhinovirus, RSV, influenza, parainfluenza, coronavirus, human metapneumovirus & adenovirus
What are the non-infectious causes of COPD exacerbations?
Pollution
Temperature decrease
What are the symptoms of an acute exacerbation of COPD?
Increased cough Increased sputum volume &/or purulence Increasing dyspnoea or wheeze Chest tightness Fluid retention
How would you assess exacerbation severity of COPD?
RR O2 saturations Degree of air entry Tachycardia Peripheral perfusion Conscious level Mental state
