COPD Flashcards
(37 cards)
What does COPD stand for?
Chronic Obstructive Pulmonary Disease
What is COPD?
A lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible.
What is the GOLD definition of COPD?
COPD is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases.
What is the biggest risk factor for COPD in high/middle income countries?
Tobacco smoke
What is the biggest risk factor for COPD in low income countries?
Exposure to indoor air pollution, such as use of biomass fuels for cooking and heating
What is Alpha-1 Antitrypsin deficiency?
Rare, inherited disease that presents with early onset COPD <45yrs
What is alpha-1 antitrypsin (AAT)?
A protein inhibitor made in the liver (limits damage caused by activated neutrophils releasing elastase in response to infection/cigarette smoke)
What percentage of smokers develop COPD during their lifetime?
<50%
What does smoking in pregnancy effect?
May affect foetal lung growth and priming of the immune system
What are common symptoms of COPD?
- cough
- breathlessness
- sputum
- frequent chest infections
- wheezing
What are some not so common symptoms of COPD?
- weight loss
- fatigue
- swollen ankles
What would you find during an examination that leads to diagnosed COPD?
- cyanosis (blue skin or lips)
- raised JVP
- cachexia (wasting syndrome that leads to loss of skeletal muscle and fat)
- wheeze
- pursed lip breathing
- hyperinflated chest
- use of accessory muscles
- peripheral oedema
What are the different levels of the mMRC dyspnoea (diss-knee-ah) scale?
0 - i only get breathless with strenuous exercise
1 - i get short of breath when hurrying on level ground or walking up a slight hill
2 - on level ground, i walk slower than people of the same age because of breathlessness, or have to stop for breath when walking at my own pace
3 - i stop for breath after walking about 100 yards or after a few minutes on level ground
4 - i am too breathless to leave the house or i am breathless when dressing
What factors mean you should diagnose COPD?
- typical symptoms
- > 35 years
- presence of risk factor (smoking or occupational exposure)
- absence of clinical features of asthma
AND
- airflow obstruction confirmed by post-bronchodilator spirometry
What percentages in spirometry is associated with each stage?
Stage 1 - mild - 80% or higher
Stage 2 - moderate - 50-79%
Stage 3 - severe - 30-49%
Stage 4 - very severe - less than 30%
What are symptoms that get worse due to acute exacerbation of COPD?
- SOB
- wheeze
- chest tightness
- cough
- sputum (purulence/volume)
- unable to smoke
- systemic upset (eating, drinking, ADLs)
- temp
- fatigue
What are the additional signs of severe exacerbation of COPD?
- breathless (RR>25/min)
- accessory muscle use at rest
- purse lip breathing
- cyanosis (sats <92% on air)
- significant decrease in exercise tolerance
- signs of sepsis (if exacerbation caused by infection)
- fluid retention
- confusion
What are the differential diagnoses for acute exacerbation of COPD?
- pneumonia
- PE
- MI
- LVF
- lung cancer
- pleural effusion
- pneumothorax
What is the management plan for acute exacerbation of COPD?
- change in inhalers (technique, device, add bronchodilator, increase or add inhaled steroid)
- oral steroids (prednisolone tablets)
- antibiotics
- self management for select patients
What are the common triggers for acute exacerbation of COPD?
- viral/bacterial infection (most common)
- sedative drugs
- pneumothorax
- trauma
What tests would you perform for acute exacerbation of COPD?
- CXR
- blood gases
- full blood count (FBC)
- U&E
- sputum culture
- VTS
What is the treatment for acute exacerbation of COPD?
- oxygen
- nebuliser bronchodilator (B2 & anti-muscarinic)
- oral/IV corticosteroid +/- antibiotic
How do you measure severity of COPD?
- spirometry
- nature and magnitude of symptoms (MRC breathlessness scale + COPD assessment tool)
- history of moderate and severe exacerbations and future risk (number per year, hospitalisation?)
- presence of co-morbidity (heart disease, artial fibrillation, obesity…)
What is cor pulmonale?
Abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels
