COPD Flashcards
Obstructive Lung Diseases
What is COPD?
COPD is a long-term, progressive condition of the lungs that involves airway obstruction, chronic bronchitis and emphysema.
What is Chronic bronchitis and what symptoms does it result in?
What is emphysema?
Chronic bronchitis is the inflammation of the bronchi that causes long-term cough and sputum production.
Emphysema is the damage and enlargement/dilation of the alveolar sacs and alveoli that causes a reduction in the surface area for gas exchange.
What are the typical presentations of COPD?
- Usually occurs in long-term smokers
- Cough
- Wheeze
- Sputum production
- Shortness of Breath
- Recurrent infections, particularly during the winters
Which signs or symptoms are NOT seen in COPD? What might they suggest instead?
- Finger clubbing
- hemoptysis
- chest pain
These symptoms may suggest lung cancer, fibrosis or heart failure instead.
Describe what each grade (1-5) in the MRC Dyspnoea scale indicates.
1- breathless upon strenuous exercise
2-breathless while walking up a hill
3- breathless that slows walking on a flat surface
4- breathlessness that stops them from walking more than 100 meters
5- cannot leave the house due to breathlessness
How is COPD Diagnosed?
Combination of clinical presentations and history along with spirometry (FEV1: FVC ratio less than 70%).
If reversible obstruction is noted when treated with salbutamol (short-acting beta agonist), it is more likely to be Asthma.
What are the four stages of severity that can be graded using the FEV1 values?
Stage 1 (mild)- above 80%
Stage 2 (moderate)- 50-79%
Stage 3 (severe)- 30-49%
Stage 4 (very severe)- less than 30%
What other investigations can be done to rule out other conditions?
- FBC- to detect chronic hypoxia, anaemia and infection
- Chest x-rays- to rule out lung cancers
- CT thorax- to rule out cancer, fibrosis or bronchiectasis
- BMI- sudden weight loss may suggest a severe condition
- ECG and echo for heart failure or cor pulmonale
- Sputum culture for chronic infections such as pseudomonas
- TLCO- tests the diffusion of inhaled gases in the blood (reduced in COPD)
What are the long-term management strategies for COPD?
- smoking cessation
- pulmonary rehab
- pneumococcal and annual flu vaccines
What is the initial medical treatment for COPD?
- short acting beta agonists (salbutamol)
- short acting muscurinic antagonists (ipratopium bromide)
- SABA+ SAMA
What is next step of treatment with and without asthmatic features?
Without:
- long-acting beta-agonist
- long-acting muscarinic antagonist
- LABA+ LAMA
With:
- long-acting beta-agonist
- Inhaled corticosteroids
- LABA+ ICS
What are some other treatment options in severe cases of COPD? What would you use to treat exacerbations?
- Oral mucolytic therapy (carbocysteine)
- prophylactic antibiotics
- oral theophylline (bronchodilator)
- Lung volume reduction therapy
- long-term Oxygen therapy
- oral corticosteroids
- nebulizers (salbutamol, etc)
For Exacerbations:
- Oral corticosteroids (prednisolone)
- Oral ABs (doxycycline)
What needs to be monitored in patients that are taking azithromycin?
- liver function and ECG changes before and during the treatment
What is cor pulmonale? What is the physiology behind it?
Refers to right-sided heart failure secondary to a respiratory disease.
The increased pressure and resistance in the pulmonary arteries (pulmonary hypertension) limits the right ventricle pumping blood into the pulmonary arteries. This causes back-pressure into the right atrium, vena cava and systemic venous system.
Often patients with early cor pulmonale are asymptomatic, what are the symptoms of cor pulmonale?
- shortness of breath on exertion
- syncope
- peripheral odema
- chest pain
What are the clinical signs of cor pulmonale?
- hypoxia
- cyanosis
- raised JVP (due to a back-log of blood in the jugular veins)
- peripheral oedema
- loud second heart sound
- murmurs (pan-systolic in tricuspid regurgitation)
- parasternal heave
- hepatomegaly (due to back pressure in the hepatic vein)
What does the management of cor pulmonale involve? What is its prognosis like?
- involves managing the symptoms- diuretics for peripheral oedema, long-term oxygen therapy
- prognosis is often poor unless there is a reversible underlying cause
What does an acute exacerbation of COPD look like?
rapidly worsening symptoms of COPD such as cough, wheezing, sputum production, and shortness of breath which usually are triggered by a viral or bacterial infection.
- also presents with respiratory acidosis (low pH, low O2, raised pCO2, raised bicarb)
What other investigations are done during an acute exacerbation of COPD?
- Chest X-rays- to look for pneumonia
- ECG- to check for any arrhythmias or heart strain
- Full blood count to look for infection (raised white blood cells)
- U&E to check electrolytes, which can be affected by infections and medications
- Sputum culture
- Blood cultures in patients with signs of sepsis (e.g., fever)
What is the target O2 for COPD patients who are retaining CO2? Which masks are used to deliver oxygen of specific concentration?
88-92%
Venturi masks
What is the first-line management of acute exacerbation of COPD?
- nebulizers with salbutamol
- antibiotics if infection found
- steroids
- resp physiotherapy can be used to clear sputum
What additional treatment options are used in severe cases of acute exacerbations of COPD?
- IV aminophylline
- Non-invasive ventilation (NIV)
- Intubation and ventilation with admission to intensive care
How do you manage a COPD exacerbation?
1) Oxygen- should aim for between 88-92%
2) High-dose SABA- nebulized
3) High-dose corticosteroids
4) Antibiotics (depends on whether the patient presents with infection)
5) Reassess after an hour
What is the difference between Type I and Type II respiratory failure?
Type I:
- hypoxaemic failure
- PaO2 of less than 8kPa. It indicates a serious underlying pathology with the lungs such as infection, oedema or a shunt.
Type II:
- ventilatory failure
- PaCO2 is more than 7kPa. Reduced ventilatory effort can be a result of gas trapping, such as in COPD and severe asthma, due to chest wall deformities, muscle weakness or central causes of respiratory depression
