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CP3 @ UoN - Medicine & Surgery > COPD > Flashcards

COPD Flashcards

1
Q

Define COPD

A

COPD is a progressive disorder characterised by airway obstruction with little or no reversibility, associated w/ an abnormal inflammatory response (typically to cigarette smoke)

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2
Q

What conditions comprise COPD?

A

Chronic Bronchitis (inc airway resistance)
Bronchiolitis
Emphysema (dec outflow pressure)

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3
Q

What is Chronic Bronchitis?

A

Inflammation of bronchi –> mucus production

Cough & sputum production on most days for 3/12 of 2 successive years

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4
Q

What is Emphysema?

A

Enlarged air spaces distal to terminal bronchioles w/ destruction of alveolar walls but no fibrosis
Breathlessness

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5
Q

What is bronchiolitis?

A

Inflammation of airways <2mm in diameter –> scarring and narrowing
-first change in COPD

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6
Q

What are the pathological features of chronic bronchitis?

A

Hypertrophy/Hyperplasia of mucous glands

Frequent LRTIs - 2o inflammation, sq metaplasia

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7
Q

What is the Reid index?

A

Ratio of gland:wall thickness in bronchus

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8
Q

What causes alveolar destruction in emphysema?

A

Extracellular proteases (inflam cells)

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9
Q

What is the most common form of emphysema?

A

Centrilobular emphysema

  • changes limited to central part of lobule
  • normal alveoli elswhere
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10
Q

What is panacinar emphysema?

A

Destruction/distension of whole lobule

-more common in a1-antitryspin deficiency

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11
Q

What are the risk factors for COPD?

A 
Cigarette smoke exposure
Occupational dust exposure
a1-antritrypsin deficiency
Recurrent chest infections in childhood
Low socioeconomic status
Asthma/atopy
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12
Q

How does COPD present?

A 
Productive morning cough
Increased LRTIs
Progressive dyspnoea w/ wheeze
Resp failure
RHF (cor pulmonale)
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13
Q

What are the signs of COPD?

A

Mild - widespread wheeze
Severe
- tachypnoea, cyanosis, flapping tremor
- hyperinflation, intercostal recession, resp distress
- raised JVP, poor chest exapnsion, hyper-resonant chest
- decreased breath sounds, prolonged exp phase, polyphonic wheeze
NEVER CLUBBING

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14
Q

What are the common complications of COPD?

A 
Acute exacerbations
Polycythaemia
Resp failure
Cor pulmonale
Pneumothorax
Lung carcinoma
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15
Q

What are the two main groups of COPD pts?

A

Blue bloaters

Pink puffers

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16
Q

What are blue bloaters?

A

Pts w/ severe COPD who are insensitive to CO2

Rely on hypxoic drive to stimulate resp effort

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17
Q

What are the features of blue bloaters?

A

Not breathless

Cyanosed & oedematous

18
Q

What ABG features are common in blue bloaters?

A

Type 2 resp failure

19
Q

What is the key management difference in blue bloaters?

A

Give O2 w/ care, can compromise resp drive

20
Q

What are pink puffers?

A

Pts sensitive to CO2

21
Q

What are the features of pink puffers?

A

Tachypnoeic
Tachycardic
Breathless but not cyanosed
Can progress to Type 1 resp failure

22
Q

What investigations are appropriate in suspected COPD?

A 
Clinical diagnosis if typical sx in pt >35 w/ risk factor
Post-bronchodilator spirometry
CXR
FBC (anaemia, polycythaemia)
Sputum culture
ECG (RV hypetrophy)
ABG
DLCO
23
Q

How can spirometry be used to stage COPD?

A 
Stage 1 (mild) - FEV1 <80% predicted
Stage 2 (mod) - FEV1 50-79% predicted
Stage 3 (sev) - FEV1 30-49% predicted
Stage 4 (v. sev) - FEV1 <30% predicted
24
Q

What features on CXR are suggestive of COPD?

A 
Hyperinflation (6ant, 10post)
Flattened hemidiaphragms
Large central pulmonary aa
Reduced periph vasc markings
Bullae
25
Q

What is the conservative management for stable COPD?

A

Refer to resp specialist if uncertain dx/worsening
Patient education
Action plan/rescue med for exacerbations
Lifestyle advice (smoking cess)

26
Q

What medications are used to treat stable COPD?

A

SABA/SAMA
LABA/LAMA
ICS

27
Q

What are the 1st line medications for stable COPD?

A

SABA OR SAMA as required

28
Q

What are the 2nd line medications for stable COPD?

A

FEV1>50% - Add LABA or LAMA (in place of SA)

FEV1<50% - Add LABA + ics & replace SAMA w/ LAMA

29
Q

What are the 3rd line medications for stable COPD?

A

LAMA + LABA + ics

30
Q

What are the specialist treatments for COPD?

A 
Pulmonary rehabilitation 
Oral aminophylline/theophylline
Mucolytics
Nutritional supplementation
LTOT
31
Q

Describe pulmonary rehabilitation

A

Consider if person disabled by COPD
Improves exercise/breathlessness/QOL
3 sessions/6 weeks

32
Q

What are the indications for LTOT?

A 
SpO2 <92%
FEV1 <30%
Cyanosis
2o polycythaemia
Cor pulmonale
33
Q

How much must LTOT be used by to increase survival?

A

> 15h/day

34
Q

How much does LTOT increase survival by?

A

3yr survival increased by >50%

35
Q

What are the surgical options for COPD?

A

Pleurectomy
Bullectomy
Lung volume reduction surgery

36
Q

What causes an acute exacerbation of COPD?

A

Bacterial/viral infections

Pollutants

37
Q

When should hospital admission be considered for an acute exacerbation of COPD?

A 
Severe breathlessness
Rapid sx onset
Acute confusion
Cyanosis
O2 sats <90%
Worsening peripheral oedema
38
Q

What outpatient management can be used for managing an acute exacerbation of COPD?

A

Increase dose/freq SABA
Prednisolone 30mg for 7-14/7
Oral a/b if purulent sputum

39
Q

What inpatient management can be used for managing an acute exacerbation of COPD?

A

O2 titrated to 88-92% sats

-28% venturi at 4L/min

40
Q

What smoking cessation options are available for COPD pts?

A

National campaigns, advertisement bans, taxes
Specialised clinics
NRT/bupropion if >10/day

41
Q

When should pharmacological treatments for smoking cessation be used?

A

Only in pts who commit to an initial stop date

CP3 @ UoN - Medicine & Surgery (135 decks)

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