copd Flashcards
3 parts of COPD
Chronic bronchitis - productive cough
Emphysema - permanent enlargement of airspaces
Airflow obstruction/small airway disease - wheeze
Why do airways narrow
Chronic irritation of bronchi by inflammation
& Bronchoconstriction
Why do airways collapse
Destruction of alveolar walls - may lead to bullae
Airway damage
Chronic inflammation Increased goblet cells Mucus cell hyperplasia Fibrosis Narrowing and reduction in number of small airways Airway collapse
Diagnosis
Exertional breathlessness, productive cough, wheeze
Risk factors - smoking, and age >35 years
Spirometry
Physical signs
Barrel shaped chest
Hyperresonant on percussion
Accessory muscle
Low BMI & nicotine staining
Effects on gas exchange
Hypoxia, hypercapnia
Raised pulmonary artery pressure
RV dilation
Cor pulmonale
Treatment/management
LABA/LAMA combined inhaler if symptomatic Flu vaccination Theophylline Azithromycin 3x/week Lung volume reduction surgery Lung transplantation
Exacerbation treatment
SABA, steroids, antibiotics
Target sats 88-92%
Consider diuretics
Treatment failure - 3 stages
Decompensated hypercapnia respiratory failure - non invasive ventilation
Resp failure despite nebuliser therapy and controlled O2 - invasive mechanical vent
Resp failure on background of significant decline, non reversible - palliate
Symptom control
Oromorph Lorazepam Fan/O2 therapy CBT Breathing strategies
