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Medicine > Respiratory - COPD > Flashcards

Respiratory - COPD Flashcards

1
Q

What is COPD?

A

Long-term progressive condition
- Airway obstruction
- Chronic bronchitis
- Emphysema

Treatable but not reversible

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2
Q

What is chronic bronchitis?

A

Long-term symptoms of a cough and sputum production due to inflammation of the bronchi

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3
Q

What is emphysema?

A

Damage and dilatation of the alveolar sacs and alveoli decreasing surface area for gas exchange

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4
Q

How reversible is airway obstruction?

A

Minimally reversible, patients susceptible to exacerbations

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5
Q

How does COPD present?

A

Long-term smoker with:
- SOB
- Cough
- Sputum production
- Wheeze
- Recurrent respiratory infections especially in winter

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6
Q

What is the MRC Dyspnoea scale?

A

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

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7
Q

How is COPD diagnosed?

A

Clinical presentation
Spirometry

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8
Q

What does COPD show with spirometry?

A

Obstructive picture

Little or no response to reversibility

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9
Q

How is severity of COPD graded?

A

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%

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10
Q

What other investigations are done for COPD?

A

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

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11
Q

What is the long-term management of COPD?

A

Smoking cessation
Pneumococcal and annual flu vaccine
Pulmonary rehabilitation
Medical treatment

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12
Q

What is pulmonary rehabilitation?

A

MDT approach to help improve function and QoL including exercise, lifestyle advice and education

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13
Q

What is the initial medical treatment for COPD?

A

SABA (salbutamol)
SAMA (ipratropium bromide)

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14
Q

What is the second step of COPD medical treatment determined by?

A

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

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15
Q

What is the final step for COPD management?

A

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)

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16
Q

When is long-term oxygen therapy used?

A

Severe COPD
- Chronic hypoxia
- Polycythaemia
- Cyanosis
- Cor pulmonale

Cannot give to smokers due to fire risk

17
Q

What causes Cor pulmonale?

A

Pulmonary hypertension

Limits RV pumping into pulmonary arteries causing back-pressure into RA, vena cava and systemic venous system

18
Q

What conditions cause cor pulmonale?

A

COPD
PE
Interstitial lung disease
CF
Primary pulmonary hypertension

19
Q

What are the signs of cor pulmonale on examination?

A

COR PULM
Cyanosis
Oedema
Raised JVP

Parasternal heave
Underperfused
Loud second heart sound
Murmurs

20
Q

What is a common trigger of a COPD exacerbation?

A

Viral or bacterial infection

21
Q

What does an acute exacerbation of COPD look like on an ABG?

A

Low pH
Low pO2
Raised pCO2
Raised bicarbonate

22
Q

Why are the target sats 88-92% for COPD oxygen therapy?

A

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

23
Q

What masks are used for COPD oxygen therapy?

A

Venturi

Can deliver specific oxygen concentration

24
Q

What is the management of an acute exacerbation of COPD?

A

Inhalers or nebulisers
Steroids (prednisolone for 5 days)
Antibiotics if evidence of infection
Respiratory physiotherapy

25
Q

How are severe acute exacerbations of COPD managed?

A

IV aminophylline
Non-invasive ventilation
Intubation and ventilation and admission to ICU

Doxopram, respiratory stimulant if NIV or intubation not suitable

26
Q

What are the criteria for using non-invasive ventilation?

A

Persistent respiratory acidosis
Potential to recover

27
Q

What are the contraindications to NIV?

A

Untreated pneumothorax
Structural pathology in face, airway or GI tract

28
Q

When using NIV what must be done until acidosis resolves?

A

Hourly ABGs
IPAP increase until acidosis resolves

Medicine (111 decks)

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