COPD Flashcards
(16 cards)
What is COPD
Non-reversible chronic inflammation of the airways caused by exposure to noxious particles or gases.
Umbrella term for types of obstructions:
Emphysema - loss of parenchymal lung texture
Chronic bronchitis - cough+sputum production for at least 3 months for 2 consecutive years
What are the risk factors for COPD
Smoking
Occupational exposure
Genetics (alpha-1 antitrypsin deficiency - it’s function is to protect lungs from damage - consider in <40 year olds)
Air pollution
When do you suspect a diagnosis of COPD?
Suspect COPD in people aged over 35 years with a risk factor and one or more of the following symptoms:
Breathlessness — typically persistent, progressive over time, and worse on exertion
Chronic/recurrent cough
Regular sputum production
Frequent LRTI
Wheeze
What are some other symptoms of COPD?
Weight loss, anorexia, and fatigue — common in severe COPD, but other causes must be considered
Waking at night with breathlessness
Ankle swelling —cor pulmonale
Signs of COPD
Cyanosis
Raised JVP and/or peripheral oedema (may indicate cor pulmonale)
Cachexia
Hyperinflation of the chest
Use of accessory muscles and/or pursed lip breathing
Wheeze and/or crackles on auscultation of the chest
How do you confirm a diagnosis of COPD?
Use spirometry (can check reversibility):
FEV1/FVC less than 0.7 confirms persistent airflow obstruction
In obstructive pattern:
FEV1 and FVC <80% (FEV1 is usually lower)
What is the grading for FEV1 values when the ratio is <0.7?
Stage 1: mild — FEV1 80% of predicted value or higher
Stage 2: moderate — FEV1 50–79% of predicted value
Stage 3: severe — FEV1 30–49% of predicted value
Stage 4: very severe — FEV1 less than 30% of predicted value or FEV1 less than 50% with respiratory failure
What is Cor Pulmonale?
Cor pulmonale is right heart failure secondary to lung disease, and is caused by pulmonary hypertension as a consequence of hypoxia
Peripheral oedema
Raised JVP
Systolic parasternal heave
Hepatomegaly
What scoring systems can you use to assess severity of COPD and informs management?
CAT (COPD Assessment Tool) - looks at range of symptoms of COPD - >10 high symptom burden
mMRC - looks at effect of SOB on ADL >2 means significant breathlessness
Group A: what is the management?
Modified MRC questionnaire: 0-1
CAT: 0-10
0-1 moedrate exacerbations that did not lead to hospitalisation
Offer bronchodilator: SABA (salbutamol) or SAMA (Ipratropium)
Group B: what is the management?
Modified MRC questionnaire >2
CAT >10
0-1 moedrate exacerbations that did not lead to hospitalisation
LABA (examples include Salmeterol) +LAMA (e.g. Iotropium)
Group E: what is the management?
2 or more moderate exacerbations or 1 or more exacerbations leading to hospitalisation
LABA+LAMA
Consider ICS if blood eosinophils are greater than 300 cells per microlitre (Steroid responsiveness - more effective at high eosinophil count)
What are the requirements to refer for Long Term O2 therapy (LTOT)?
If they have:
O2 - 92% or less breathing air
Very severe (FEV1<30%) or severe (FEV1 30–49% predicted) airflow obstruction
Cyanosis
Polycythaemia
Peripheral oedema
Raised JVP
Must not smoke while on LTOT - risk of fire/explosion
How to manage acute exacerbation of COPD?
Aim for O2 sats of 88-92%
O2 given via:
A 24% Venturi mask at 2-3 L/min
A 28% Venturi mask at 4 L/min
Nasal cannulae at 1-2 L/min
Type 1 vs Type 2 Respiratory Failure
Type 1 - Low O2
Type 2 - Low O2 and raised CO2 (hypercapnia)
How do you manage acute exacerbation of COPD but they do not require hospital admission?
Oral Prednisolone
Consider oral anitbiotics
