Case 10 - COPD Flashcards
(37 cards)
What is COPD?
Multifactorial disease made up of asthma, emphysema, bronchitis (production of sputum for more than 3 months of the year) etc.
Progressive airway obstruction that is not reversible
How does smoking lead to COPD?
Toxic products of smoke > activate macrophages and dendritic cells > activates T cells (emphysema), fibroblasts (bronchiolitis) and proteases (mucus hypersecretion)
What are the genetic causes of COPD?
Genetic:
- Alpha-1-antitrypsin deficiency
- Matrix metalloproteinases
- TNF-alpha
- Glutathione S transferase
How is COPD graded?
GOLD staging and NICE staging
GOLD I (Mild) - FEV1 >80% GOLD II (Moderate) FEV 50-79% GOLD III (Severe) FEV1 30-49% GOLD IV (V Severe) FEV1<30%
What are differentials for COPD?
What questions should you ask to exclude these?
PE Asthma Angina Lung fibrosis Restrictive lung disease
Any similar episodes? PND? Orthopnea? Peripheral oedema? Any chest pain? Light-headedness? Ever owned a bird? Asbestos exposure? Smoking history?
What questions should you ask in a smoking history?
Have you ever smoked? When did you start? When did you stop? Do you still smoke? Cigarettes/roll-ups? How many a day? Ever more or less? Ever tried to quit? Ever taken a break? Anyone else in the house smoke?
What are blue bloaters and pink puffers?
T2RF - blue bloaters. Tend to be larger patients with increased fluid retention and breathing effort due to gas trapping
T1RF - pink puffers. Tend to be cachexic patients who have underlying pathology
What is the triad of COPD symptoms?
SOB
Chronic cough
Daily sputum production
What are symptoms of COPD?
SOBOE
Cough - productive of white frothy sputum
Wheeze
Winter exacerbations
What are signs of COPD?
Hyperinflation of chest Expiratory wheeze Reduced breath sounds Cachexia Decreased cricosternal distance Tar staining of fingers Increased RR Paradoxical lower chest movements Tracheal tug Indrawing of intercostals Palpable liver edge
What would clubbing or lymphadenopathy in COPD suggest?
Cancer, these are not usual in COPD
How can we categorise patients’ COPD symptoms?
Can categorise dyspnoea using MRC 1-5 score
Then using spirometry, BMI, exacerbation frequency and MRC can put patient into a phenotype
What would spirometry show in COPD?
Obstructive, non-reversible picture
FEV1:FVC ratio will be <70% and FEV1 will be reduced more than FVC
However, patients can still feel healthy with very low FEV1, so not a good symptomatic indicator
What does CXR show in COPD?
May not show anything May see: -Hyperinflation of lungs -Flattened hemi-diaphragms -Blunting of costophrenic angles -Reduced upper lobe markings
What would CT show in COPD?
Can see the emphysematous bullae and bronchial wall thickening
What are the complications of COPD?
Exacerbation Cor pulmonale Pneumonia Pneumothorax Cachexia Peripheral neuropathy
What are the symptoms and causes of exacerbations of COPD?
Increased SOB Increased sputum production (green/yellow) Coryzal symptoms Increased cough Sputum purulence Ankle swelling
Often due to S.pneumoniae, pseudomonas or H.Influenzae
What is cor pulmonale?
RHF due to COPD Hypoxia > pulmonary artery vasoconstriction Increased pulmonary artery pressure Leads to increased RV contraction RVH RVF
What is the treatment order for COPD?
1) SABA
2) SABA and LABA/LAMA
3) SABA and LABA/LAMA and ICS in those with FEV1:FVC <50% or frequent exacerbators
4) SABA and LABA and LAMA and ICS
5) Oral theophylline/high dose bronchodilators/pulmonary rehab
SABA types and SEs
Salbutamol (ventolin)
Terbutaline (bricanyl)
Tremor
Tachycardias
Arrhythmias
Myocardial ischaemia
LABA types and SEs
Salmeterol (serevent)
Formeterol (oxis)
Tremor
Tachycardias
Arrhythmias
Myocardial ischaemia
Steroid types and SEs
Beclamethosone (becotide)
Budenoside (pulmicort)
Increased oral thrush
Increased risk of pneumonia due to immune suppression
Dry mouth/hoarse voice
Adrenal suppression
Anti-muscarinics types and SEs
Tiotropium (LAMA)
Ipratropium (SAMA)
Dry mouth
Nausea
Headache
Theophylline SEs
Tachycardia
Toxicity
Anaphylaxis
