Respiratory - COPD Flashcards
What is COPD?
Long-term progressive condition
- Airway obstruction
- Chronic bronchitis
- Emphysema
Treatable but not reversible
What is chronic bronchitis?
Long-term symptoms of a cough and sputum production due to inflammation of the bronchi
What is emphysema?
Damage and dilatation of the alveolar sacs and alveoli decreasing surface area for gas exchange
How reversible is airway obstruction?
Minimally reversible, patients susceptible to exacerbations
How does COPD present?
Long-term smoker with:
- SOB
- Cough
- Sputum production
- Wheeze
- Recurrent respiratory infections especially in winter
What is the MRC Dyspnoea scale?
5-point scale for breathlessness
1- Strenuous exercise
2- Walking uphill
3- Breathlessness that slows walking on the flat
4- Can’t walk more than 100m
5- Can’t leave the house
How is COPD diagnosed?
Clinical presentation
Spirometry
What does COPD show with spirometry?
Obstructive picture
Little or no response to reversibility
How is severity of COPD graded?
FEV1
Stage 1 (mild)- FEV1 more than 80% predicted
Stage 2 (moderate)- FEV1 50-79%
Stage 3 (severe)- FEV1 30-49%
Stage 4 (very severe)- FEV1 under 30%
What other investigations are done for COPD?
BMI
CXR
FBC, for polycythaemia, raised Hb due to chronic hypoxia, anaemia and infection
Sputum culture
ECG
CT thorax
Serum alpha-1 antitrypsin
Transfer factor for carbon monoxide
What is the long-term management of COPD?
Smoking cessation
Pneumococcal and annual flu vaccine
Pulmonary rehabilitation
Medical treatment
What is pulmonary rehabilitation?
MDT approach to help improve function and QoL including exercise, lifestyle advice and education
What is the initial medical treatment for COPD?
SABA (salbutamol)
SAMA (ipratropium bromide)
What is the second step of COPD medical treatment determined by?
If there are asthmatic of steroid responsive features
- Previous asthma diagnosis
- Variation of FEV1 more than 400 mls
- Diurnal variation in peak flow
- Raised eosinophil count
No asthmatic or steroid features
- LABA
- LAMA
Anoro Ellipta
Asthmatic or steroid features
- LABA
- ICS
Fostair, Symbicort
What is the final step for COPD management?
LABA
LAMA
ICS
Trimbow inhaler
More severe cases use
- Nebulisers
- Oral theophylline
- Oral mucolytics (carbocisteine)
- Prophylactic antibiotics e.g. azithromycin (will need ECG and liver function before starting)
When is long-term oxygen therapy used?
Severe COPD
- Chronic hypoxia
- Polycythaemia
- Cyanosis
- Cor pulmonale
Cannot give to smokers due to fire risk
What causes Cor pulmonale?
Pulmonary hypertension
Limits RV pumping into pulmonary arteries causing back-pressure into RA, vena cava and systemic venous system
What conditions cause cor pulmonale?
COPD
PE
Interstitial lung disease
CF
Primary pulmonary hypertension
What are the signs of cor pulmonale on examination?
COR PULM
Cyanosis
Oedema
Raised JVP
Parasternal heave
Underperfused
Loud second heart sound
Murmurs
What is a common trigger of a COPD exacerbation?
Viral or bacterial infection
What does an acute exacerbation of COPD look like on an ABG?
Low pH
Low pO2
Raised pCO2
Raised bicarbonate
Why are the target sats 88-92% for COPD oxygen therapy?
Patients have chronic hypoxia
Sudden increase in oxygen will cause the respiratory drive to decrease
This causes a rise in carbon dioxide causing oxygen-induced hypercapnia
Can only increase oxygen sats to 94-98% if they do not retain CO2
What masks are used for COPD oxygen therapy?
Venturi
Can deliver specific oxygen concentration
What is the management of an acute exacerbation of COPD?
Inhalers or nebulisers
Steroids (prednisolone for 5 days)
Antibiotics if evidence of infection
Respiratory physiotherapy
