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Flashcards in COPD Deck (21):
0

What investigations can be done in the diagnosis of COPD?

Spirometry
CXR
ABG
Hb and PCV may be raised
Serum A1AT
ECG

1

What are the complications of COPD?

Recurrent pneumonia
Pneumothorax
Resp failure
Cor pulmonale

2

We can give oxygen therapy in the management of COPD. What is the ideal oxygen saturation?

88-92%

3

What are the two most likely causative organisms of pneumonia in a patient with COPD?

Strep pneumoniae and h.influenzae

4

What is meant by COPD?

COPD is characterised by airflow obstruction. The airflow obstruction is usually progressive, not fully reversible and does not change markedly over several months. The disease is predominantly caused by smoking

5

What is involved in the outpatient management of COPD?

COPD care bundle
Smoking cessation (cost-effective if intensive counselling with pharmacotherapy)
Pulmonary rehabilitation
Bronchodilators, antimuscarinics
Steroids, mucolytics
Diet - BMI is a prognostic tool, dietician referral if BMI outside 20-25
LTOT if appropriate, lung volume reduction if appropriate
Vaccinations: one-off strep, annual h. Influenza

6

What happens in pulmonary rehabilitation?

Break the cycle of deconditioning, many patients with COPD avoid exercise and physical activity due to breathlessness
MDT 6-12week programme of supervised exercised, unsupervised home exercise, nutritional advice and disease education

It is useful to start this within 4 weeks following a hospital admission with an exacerbation
For MRC 3+

7

What happens in the management and treatment of a COPD exacerbation?

ABCDE
Oxygen (via a fixed performance face mask due to risk of CO2 retention, sats 88-92%)
NEBs - salbutamol, ipratropium
Steroids - prednisolone 30mg STAT and OD for 7 days
Abx - if CRP/WCC raised or purulent sputum
CXR
Consider IV aminophylline
Consider NIV if T2RF and pH 7.25-7.35
If pH less than 7.25 consider ITU referral

8

What is meant by an acute exacerbation in COPD?
What are the two different categories?

Change in day to day sob, cough and sputum production
Infective e.g. Pneumonia
Non-infective e.g. Cold weather, smoking, exercise

9

What are the late features of COPD?

Central cyanosis, flapping tremors due to increase pCO2, right sided heart failure

10

What happens in long-term oxygen therapy?

Continuous oxygen, 16hr/day for a survival benefit
Offered if pO2 consistently below7.3kPa (92% sats or below)or 8kPa with RSHF
Patients must be non-smokers and not retain high levels of CO2

Also if pedal oedema, polycythaemia, raised JVP, cyanosis

11

What are the key indicators for the investigation of alpha-1-antitryptin deficiency?

Patients who develop emphysema before 45
Absence of risk factors
Strong family history

12

How is the diagnosis of alpha-1-antitrypsin deficiency made?

Serum a1AT levels and phenotyping

13

Which part of the lungs are primarily affected in a1AT?

How does this differ to smoking-related emphysema?

Early onset panlobular emphysema - lower lobes

Centrilobular emphysema - apical disease

14

What can be seen on a chest x-Ray in a patient with COPD?

Barrel chest. Loss of elastic tissue causing the lungs to hyperinflate. Hyperexpansion. More than eight posterior or six anterior ribs can be seen.

15

What are the main causes of COPD?

Smoking, alpha-1 anti-trypsin deficiency, occupational exposure, pollution

16

What is the pathophysiology of alpha-1 anti-trypsin deficiency?

Co-dominant condition
Mutation to Chromosome 14
Normally trypsins (proteases) breakdown other molecules and alpha-1AT prevents the action of trypsin
In the lungs it protects against neutrophil elastase - elastin breakdown leading to emphysema
It is normally produced in the liver, accumulation of abnormal proteins leads to cirrhosis

17

What are the indications for NIV in COPD exacerbations?

Following controlled oxygen therapy and meds:
RR greater than 30
Increased pCO2
PH between 7.25 and 7.35

18

What is the benefit of ICS in COPD?

To reduce the frequency of exacerbations

19

What are the GOLD stages of COPD?

Mild FEV1.0 80%
Moderate 50-79%
Severe 30-49%
Very severe less than 30%

20

What are the signs and symptoms in the presentation of COPD?

Older patients, smoking history. Chronic and progressive condition
Productive cough, especially in the mornings.
Sob - initially on exertion but becomes constant as the disease progresses. Hunched over and use of accessory muscles. Pursed lip breathing.