COPD Flashcards
What is COPD?
Chronic Obstructive Pulmonary disease
Non-reversible, long-term deterioration to air flow in the lungs caused by damage to lung tissue
What is the biggest single aetiology/risk factor for COPD?
Smoking
What are people with COPD at risk of?
Exacerbation
Exacerbation caused by infection = infective exacerbation
How do patients with COPD typically present?
Long-term smoker
Chronic SOB
Cough
Sputum production
Wheeze
Recurrent respiratory infection (esp. in winter)
NOTE: COPD DOES NOT cause clubbing and it is unusual for it to cause haemoptysis
Which DDx should you consider in a patient with COPD?
Lung cancer
Fibrosis
Heart failure
What is the 5 point scale that NICE recommends for assessing COPD? What are its components?
MRC dyspnoea
Grade 1 = breathless on strenuous exercise
Grade 2 = breathless on walking up a hill
Grade 3 = breathless that slows walking on flat
Grade 4 = stop to catch breath after walking 100 m on flat
Grade 5 = unable to leave house due to breathlessness
How do you diagnose COPD?
Clinical diagnosis
Spirometry
What will spirometry show in COPD?
Obstructive picture
What would the FEV1/FVC ratio in someone with COPD be and why?
<0.7
The overall lung capacity is measured by FVC and their ability to quickly blow air out is measured by the forced expiratory volume in 1 second (FEV1). Being able to blow air out is limited by the damage to their airways causing airway obstruction
How can COPD be differentiated from asthma when doing spirometry?
Reversibility testing
In COPD there is no dramatic response to beta-2 agonist
If there is dramatic response to beta-2 agonist then consider asthma as a more likely diagnosis
How is the severity of airflow obstruction graded?
Using FEV1
Stage 1: FEV1 >80% of predicted
Stage 2: FEV1 50-79% of predicted
Stage 3: FEV1 30-49% of predicted
Stage 4: FEV1 <30% of predicted
Apart from spirometry, what other investigations can you do for people with COPD?
CXR to exclude other pathology such as lung cancer.
FBC for polycythaemia or anaemia. Polycythaemia (raised haemoglobin) is a response to chronic hypoxia.
BMI as a baseline to later assess weight loss (e.g. cancer or severe COPD) or weight gain (e.g. steroids).
Sputum culture to assess for chronic infections such as pseudomonas.
ECG and echocardiogram to assess heart function.
CT thorax for alternative diagnoses such as fibrosis, cancer or bronchiectasis.
Serum alpha-1 antitrypsin to look for alpha-1 antitrypsin deficiency. Deficiency leads to early onset and more severe disease.
Transfer factor for carbon monoxide (TLCO) is decreased in COPD. It can give an indication about the severity of the disease and may be increased in other conditions such as asthma.
What is the long-term conservative management for people with COPD?
Smoking cessation
Refer to smoking cessation services if they need help
What is the long-term pharmacological management for people with COPD?
- SABA - i.e., beta-2 agonists or short acting muscarinics (e.g., ipratropium bromide)
2a. LABA + LAMA (if they do not have asthmatic or steroid responsive features) - “Anoro Ellipta”, “Ultibro Breezhaler” and “DuaKlir Genuair” are examples of combination inhalers
2b. LABA + ICS (if they have asthmatic or steroid responsive features) - Fostair“, “Symbicort” and “Seretide” are examples of combination inhalers
2c. LABA + LAMA + ICS (if they have asthmatic or steroid responsive features and 2b has not worked) - Trimbo” and “Trelegy Ellipta” are examples of LABA, LAMA and ICS combination inhalers.
What are additional options for treatment in more severe cases pf COPD?
Nebulisers (salbutamol and/or ipratropium)
Oral theophylline
Oral mucolytics (e.g., carbocysteine) - break down sputum
Long-term prophylactic Abx (e.g., azithromycin)
Long-term O2 therapy at home
In which group of COPD patients is long-term home O2 used?
Patients with COPD causing:
- chronic hypoxia
- polycythaemia
- cyanosis
- HF secondary to pulmonary HTN
How does an exacerbation of COPD present?
Acute worsening of symptoms
Cough
Sputum production
Wheeze
Usually triggered by a bacterial or viral infection
What happens to bicarb in an exacerbation?
Bicarb is higher than in normal people in those with chronic COPD
BUT
Not enough to combat increased CO2, as kidneys can’t keep up with rising CO2
How does type 1 respiratory failure show on ABGs?
Low pO2
Normal pCO2
How does type 2 respiratory failure show on ABGs?
Low pO2
High pCO2
Apart from ABGs what other investigations would you consider for COPD?
CXR - look for pneumonia + other pathology
ECG - arrhythmia, HF
FBC - infection
U&E - electrolytes (can be affected by infections and meds)
Sputum cultures
Blood cultures
What can happen if you give someone with COPD too much O2?
Depresses their respiratory drive
Which type of mask can you give a patient to prevent giving too much O2?
Venturi
What colours are the different venturi masks and how much do they deliver?
24% (blue)
28% (white)
31% (orange)
35% (yellow)
40% (red)
60% (green)
