Respiratory: COPD Flashcards
How is COPD diagnosed?
diagnosis is based on typical clinical features, confirmed with spirometry
Who should COPD be suspected in?
- age >35 with a risk factor eg smoking/environmental/occupational
- plus one or more symptoms:
-SOB - persistent, progressive, worse on exertion - chronic/recurrent cough
- regular sputum production
- frequent LRTIs
- Wheeze
What signs may be found on examination in COPD patients?
- cyanosis
- raised JVP +/- peripheral oedema (cor pulmonale)
- cachexia
- hyperinflation of chest
- use of accessory muscles/pursed lip breathing
- wheeze and/or crackles on chest auscultation
When should alpha-1 antitrypsin deficiency be considered?
- age <40
- family Hx
What is cor pulmonale and what are the signs?
- right heart failure secondary to lung disease. Caused by pulmonary hypertension due to hypoxia.
- Signs:
-peripheral oedema
-raised JVP - systolic parasternal heave
- loud second heart sound - over pulmonary valve (2nd left intercostal space)
- hepatomegaly.
What are the grades of the Medical Research Council (MRC) dyspnoea scale?
0 Not troubled by breathlessness except during strenuous exercise
1 Short of breath when hurrying or walking up a slight hill
2 Walks slower than contemporaries on the level because of breathlessness, or has to stop for breath when walking at own pace
3 Stops for breath after walking about 100 m or after a few minutes on the level
4 Too breathless to leave the house, or breathless when dressing or undressing
Which investigations should be arranged in suspected COPD?
- BMI
- CXR (helps exclude lung cancer, TB, heart failure)
- FBC - identify anaemia or polycythaemia
- post-bronchodilator spirometry.
Others depend on situation:
* serial peak flow measurements if considering asthma.
* ECG & BNP ?heart failure
* CT thorax - if symptoms disproportionate to spirometry results- look for fibrosis/bronchiectasis (specialist advice)
* alpha 1 antitrypsin
What post-bronchodilator spirometry results indicate COPD?
- post bronchodilator ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) of less than 0.7. (FEV1/FVC <70%)
COPD should be considered in younger people with typical symptoms even if FEV1/FVC ratio is above 0.7.
Routine spirometry reversibility testing is not recommended.
Spirometry should be performed at diagnosis, when diagnosis reconsidered and for monitoring of disease severity and progression.
What are the 4 stages of COPD airflow obstruction (staged by spirometry)?
-Severity is graded according to reduction in FEV1 compared to appropriate reference values (based on age, sex, height and ethnicity):
* Stage 1, mild — FEV1 80% of predicted value or higher.
* Stage 2, moderate — FEV1 50–79% of predicted value.
* Stage 3, severe — FEV1 30–49% of predicted value.
* Stage 4, very severe — FEV1 less than 30% of predicted value or FEV1 less than 50% with respiratory failure.
When should asthma (or overlap) be considered in patient with possible COPD?
- family history
- other atopic disease
- nocturnal or variable symptoms
- is a non-smoker
- onset of symptoms <35 years of age.
How does an acute exacerbation of COPD present?
- acute onset sustained worsening of a person’s symptoms from their usual stable state
- can be triggered by: viral infection (rhinovirus), smoking, environment
Commonly report: - Increased breathlessness
- Increased cough
- Increased sputum production and change in colour
When should someone with COPD be referred to respiratory?
- ?lung cancer (eg haemoptysis or CXR features)
- Unsure if asthma or fibrosis, or symptoms disproportionate to spirometry
- very severe (FEV1 <30% predicted) or rapidly declining
- ?cor pulmonale
- <40/family Hx antitrypsin
- frequent infections - assess preventable factors and ?bronchiectasis
To assess for :
* Oxygen
* Nebuliser
* Long term NIV
* Lung surgery
When should a patient be referred for pulmonary rehab?
- MRC grade 3 or worse - functionally disabled by COPD
- or recent hospital admission for Exacerbation
DO not refer if unable to walk or unstageable angina/recent MI
When should someone with COPD be referred to consider oxygen therapy?
- Sats <=92% on air.
- Very severe (forced expiratory volume in 1 second [FEV1] less than 30% predicted) or severe (FEV1 30–49% predicted) airflow obstruction.
- Cyanosis.
- Polycythaemia.
- Peripheral oedema.
- Raised jugular venous pressure.
What non-pharmacological treatments should be offered to COPD patients?
- education, patient info
- stop smoking support
- pneumococcal and influenza vaccinations
- pulmonary rehab (if indicated)
- personalised self management plan.
