COPD Flashcards
What is the pathophysiology of COPD
neutrophilic inflammation
impaired macrophage function
bacterial colonisation
Mucus hypersecretion due to goblet cell hyperplasia – chronic bronchitis
small airway fibrosis
alveolar destruction - emphysema
hyperinflation
What is the MRC dyspnoea scale
grade 0 - breathless with strenuous exercise
grade 1- get short of breath when hurrying on level /walking up slight hill
grade 2 - Walk slower than people of same age on level/ have to stop for breaths
grade 3- stop for breath after walking 100 metres / few minutes on level
grade 4- too breathless to leave the house/ breathless when dressing /undressing
What is the tests used for COPD assessment
CAT test
score of 10 or more= symptomatic
Criteria include -
coughing
phlegm
chest tightness
breathless
limited doing activities at home
confident leaving house due to lung condition
sleep well
lots of energy
What are some causes of COPD
Alpha 1 anti-trypsin deficiency- should be suspected in younger patients with emphysematous symptoms
PIZZ genotype
Smoking
air pollution and exposure to toxins
What are some key diagnostic factors for COPD
cough - often with sputum
breathlessness
wheeze
chest tightness
chest infections
Right sided heart failure in severe cases
What are some other diagnostic factors
hyper-resonance
coarse crackles
What are 1st investigations to order for COPD
post-bronchodilator spirometry - FEV1/FVC <0.7
obstructive disease
grade breathlessness with MRC dyspnoea scale
CXR -
Bloods
FBC- eosinophil count
ABG
What other investigations to consider for COPD
sputum culture - bacteria and acid fast bacilli
CT scan to exclude bronchiectasis
BMI calculation
What will be seen on chest x ray of someone with COPD
Hyperinflation
Bullae
flat hemidiaphragm
exclude lung cancer
How do you conclude the severity of COPD
FEV1/FVC RATIO IS <0.7 in all of these
FEV1 of predicted >80% = STAGE 1 ( mild)
FEV1 of predicted 50-79% = STAGE 2( moderate)
FEV1 of predicted 30-49% = STAGE 3 (severe)
FEV1 of predicted <30% = STAGE 4 (very severe)
What is first line management for COPD
stop smoking - offer NRT , varenicline or bupropion
Influenza vaccine , one -off pneumococcal vaccine
When is pulmonary rehabilitation considered
MRC dyspnoea scale >2
What is the stepwise management for bronchodilator therapy
SABA/SAMA as required
is there asthmatic features/features suggestive of steroid responsiveness
If NO -
SABA as required
LABA and LAMA regularly
If YES
SABA/SAMA as required
LABA and ICS regularly
How do you know if there are asthmatic features or any features suggestive of steroid responsiveness
previous diagnosis of asthma /atopy
raised blood eosinophil count
substantial variation in FEV1 over time
substantial diurnal variation in peak expiratory flow
What are some contraindications for smoking cessation medications
Varenicline contraindicated in mental illness
Bupropion is contraindicated in epilepsy
