Respiratory: COPD Flashcards
How are pack years calculated?
number of pack (1 pack is 20 cigs) x number of years smoked
Briefly outline the pathophysiology of COPD
Chronic bronchitis - inflam and excessive mucus
Emphysema - alveolar membrane breakdown
What are the causes of COPD?
Smoking
Alpha 1 anti-trypsin def
What are the signs and symptoms of COPD
Cough
Chronic dyspnoea
Sputum production
Wheeze
Tachypnoea
Use of accessory muscles
Hyperinflation
Reduced expansion
Hyper-resonant
Cyanosis
What investigations should be performed when COPD is suspected?
X ray =
o Hyperinflation
o Narrow mediastinum
o Flat hemi-diaphragms
o Widely spaced out ribs
Lung function testing = scooped curve, FEV1:FVC <70, increased TLC, reduced DLCO, non- reversible
ECG = R atrial and ventricular hypertrophy
How should acute COPD be managed?
- A-E assessment
- Via a fixed performance face mask
o Due to risk of CO2 retention
o Aim for sats 88-92% being guided by ABGs
- ABG
- Neb bronchodilators = beta agonists + ipratropium bromide
- Prednisolone 30 mg PO for 5-7 days
How should chronic COPD be managed?
- Smoking cessation
- Mucolytics
- Screen for depression
- Flu and pneumococcal vaccinations
- Long term oxygen therapy - target 88-92%
- Lung volume reduction
1. SABA
2a. asthma symptoms = LABA + ICS + LAMA
2b. no asthma symptoms = LABA + LAMA
What are the possible complications of COPD?
Respiratory failure
Cor pulmonale = oedema, increased JVP
Pneumothorax = ruptured bullae
Describe the MRC Dyspnoea Scale?
1 = not troubled with breathlessness except on strenuous exercise
2 = SOB when hurrying on level ground or walking up a slight hill
3 = walks slower than most on level ground, stops after a mile or so, stops after 15 mins walking at own pace
4 = stops for breath after walking 100 yards or after a few mins on level ground
5 = too breathless to leave the house, breathless when undressing
Why might patients with COPD develop ankle oedema?
Cor pulmonale = R sided HF due to increased pressure in the pulmonary arteries = backed up systemic pressure = peripheral oedema
What does spirometry demonstrate to be compatible with a diagnosis of COPD?
Scooped curve
FEV1:FVC = <70
Increased TLC
Reduced DLCO
Non-reversible
What interventions alter prognosis (mortality) for patients with COPD?
Smoking cessation
Mucolytics
Flu and pneumococcal vaccinations
Why may uncontrolled oxygen be potentially dangerous in someone with COPD?
Chronic COPD pts can be in chronic CO2 retention = their respiratory drive is now driven by O2 levels
Giving O2 will knock out the respiratory drive = low RR
What is the role of pulmonary rehabilitation in patients with COPD?
Breaking the vicious cycle of dyspnoea - decreased activity - deconditioning - isolation
Decreasing symptoms
Improvements in exercise tolerance
Reduction of health care utilisation
Increase physical activity
How does COPD appear on CXR?
