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Stage 2: Supporting Life > Acute Exacerbations of COPD > Flashcards

Acute Exacerbations of COPD Flashcards

1
Q

What is a COPD exacerbation?

A

An acute worsening of respiratory symptoms (caused by even greater airway inflammation and narrowing) that result in additional therapy

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2
Q

What are causes of COPD exacerbations?

A

Bacteria, viruses, pollutants

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3
Q

What viruses can lead to COPD exacerbations (30%)?

A
  • Rhinovirus
  • Influenza
  • Parainfluenza
  • Respiratory syncytial virus (RSV)
  • Human metapneumovirus
  • Coronavirus
  • Adenovirus
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4
Q

What are common bacterial causes of COPD exacerbations?

A
  • Haemophilus influenzae
  • Moraxella catarrhalis
  • Streptococcus pneumoniae
  • Staphylococcus aureus
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5
Q

What is a bacterial cause common in severe COPD exacerbations?

A

Pseudomonas aeruginosa

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6
Q

What are atypical bacterial causes of COPD exacerbations?

A

Chlamydia pneumoniae, mycoplasma pneumoniae, legionella

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7
Q

What are the clinical symptoms of COPD exacerbations?

A
  • Increased breathlessness
  • Increased cough and purulent sputum production
  • Change in colour and/or tenacity of sputum
  • Wheeze
  • Runny nose and shivers
  • Mild ankle swelling/pitting oedema
  • Confusion
  • Impaired daily activities
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8
Q

How would you treat a mild COPD exacerbation?

A

Short acting bronchodilators (SABDs) only

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9
Q

How would you treat a moderate COPD exacerbation?

A

SABDs + antibiotics and/or OCS

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10
Q

How would you treat a severe COPD exacerbation?

A

Hospitalisation

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11
Q

What is classified as frequent COPD exacerbations?

A

2 or more a year

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12
Q

What are frequent COPD exacerbations associated with?

A

1) Higher mortality
2) More rapid decline in lung function
3) Poorer QoL
4) Greater airway inflammation

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13
Q

What are the cardiovascular effects of a COPD exacerbation?

A
  • Increased pulmonary arterial pressure
  • Decreased RV preload
  • Increased LV preload
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14
Q

What can the increased ventilatory drive of a COPD exacerbation lead to?

A

Decreased PaO2, increased PaCO2 and decreased pH (respiratory acidosis - T2RF)

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15
Q

What are the signs of acute exacerbation of COPD?

A
  • Higher temperature (febrile)
  • Tachypnoea
  • Tachycardia
  • Low saturations even on oxygen
  • Polyphonic wheeze
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16
Q

What investigations might you do on someone with an acute COPD exacerbation?

A

Bloods, ECG, nasal swab and sputum culture, CXR, ABG (to check for T2RF as he is hypoxic)

17
Q

What would bloods of someone with COPD exacerbation show?

A

High WCC, neutrophils and CRP and maybe low urea (dehydration)

18
Q

What would a CXR of a patient with COPD without pneumonia look like?

A

Hyperinflated, clear lung fields

19
Q

Why is there no focal abnormality on a CXR of someone with a COPD exacerbation?

A

Bc a COPD exacerbation is an airway phenomenon (tracheitis, bronchitis or alveolitis) so won’t see consolidation on a CXR

20
Q

What would the ABG of someone with a COPD exacerbation likely show?

A

Type 2 respiratory failure → (compensated if bicarbonate is high) respiratory acidosis

21
Q

What is hypoxia?

A

PaO2 < 8

22
Q

What is hypercapnia?

A

PaCO2 > 6

23
Q

What is the worst impact of a COPD exacerbation?

A

Lung attack

24
Q

What is the most common cause of a COPD exacerbation?

A

Respiratory infection

25
Q

What leads to worsening breathlessness (frightening and disabling) in a COPD exacerbation?

A
  • Increased airway inflammation
  • Increased mucus production
  • Gas trapping
  • Worsening of co-morbidities on background of limited reserve e.g. effect of steroids on diabetes
26
Q

How do you define a COPD exacerbation in terms of symptoms?

A
  • Any 2 of: increased dyspnoea, sputum volume or sputum purulence
  • OR any one of the above and any one of: increased cough, wheeze, sore throat or cold
27
Q

What pollutants can cause COPD exacerbations?

A

Ozone, particulates, sulfer dioxide, nitrogen dioxide

28
Q

What is associated with the presence of bacteria in the sputum and so should be treated with antibiotics?

A

Sputum purulence

29
Q

When is the effect of pollutants worse?

A

In warmer weather

30
Q

Why is pus green in bacterial infection>

A

Bc polymorphs release myeloperoxidase (green) which is how they engulf and destroy bacteria

31
Q

When is viral-bacterial co-infection (25%) more likely and what does it lead to?

A

In winter months → greater fall in lung function and longer hospital admission

32
Q

What are differential diagnoses of COPD exacerbation?

A

1) CAP (CXR shows consolidation) → if CXR shows anything abnormal, not just plain COPD exacerbation so need to treat cause
2) PE
3) PTX
4) Acute coronary event
5) Congestive cardiac failure

Stage 2: Supporting Life (30 decks)

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