Resp disorder - COPD Flashcards
How diagnose COPD? (pathological and clinical)
Pathological: emphysema and bronchial wall thickening
Clinical: at least 3 months of productive cough for 2+ consecutive years
What would you expect to see FEV1:FVC
Less 70% as obstructive disease
Symptoms expect to see w/ COPD?
SOBOE, wheeze, cough, weight loss
Symptoms see in exacerbation COPD?
Acute breathlessness and wheeze, worsening sputum production, fever, drowsiness
What index can determine disease severity?
BODE
What would you expect to see on examination and what does it indicate?
- Hyper-extended barrel chest
- Hypersonate
- Reduced breath sound
- Wheeze
- Elevated JVP
What signs would you see?
Muscle wasting, use accessory muscle, pursed lips, cyanosis, CO2 flap, drowsiness
What are the NICE tx of COPD?
- Smoking cessation
- Pneumoncoccal and influenza vaccination
- Pulmonary rehab if indicated
- SABA or SAMA if needed
What risk do you have with inhaled corticosteroids?
Pneumonia risk
What is theophylline?
Mucolytic - can see symptom improvement
e.g carbocisteine
Explain different types of oxygen therapy?
- LTOT - min 14hrs day w/ prognostic benefit
- Ambulatory oxygen - used for QoL - desaturation on exercise
- SBOT - palliative care (uncommon)
How to prevent exacerbations?
Seasonal vaccinations
Inhaled steroids
Pulmonary rehab
other: mucolytics and anticholinergics
What is type I respiratory failure?
Low or normal PaCO2
Common cause: asthma, pneumonia, fibrosis
What is type II respiratory failure?
Elevated PaCO2 - hypoxic (metabolic acidosis from retained CO2) (greater 6kPa)
Cause: overdose, trauma, COPD, cerebral haemorrhage
How would you tx acute respiratory acidosis and explain?
Non-invasive ventilation
- Cyclic non-invasive positive pressure delivered by mask to supply supplementary O2
