Flashcards in COPD Deck (21)
What investigations can be done in the diagnosis of COPD?
Hb and PCV may be raised
What are the complications of COPD?
We can give oxygen therapy in the management of COPD. What is the ideal oxygen saturation?
What are the two most likely causative organisms of pneumonia in a patient with COPD?
Strep pneumoniae and h.influenzae
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
What is involved in the outpatient management of COPD?
COPD care bundle
Smoking cessation (cost-effective if intensive counselling with pharmacotherapy)
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
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+
What happens in the management and treatment of a COPD exacerbation?
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
Consider IV aminophylline
Consider NIV if T2RF and pH 7.25-7.35
If pH less than 7.25 consider ITU referral
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
What are the late features of COPD?
Central cyanosis, flapping tremors due to increase pCO2, right sided heart failure
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
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
How is the diagnosis of alpha-1-antitrypsin deficiency made?
Serum a1AT levels and phenotyping
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
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.
What are the main causes of COPD?
Smoking, alpha-1 anti-trypsin deficiency, occupational exposure, pollution
What is the pathophysiology of alpha-1 anti-trypsin deficiency?
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
What are the indications for NIV in COPD exacerbations?
Following controlled oxygen therapy and meds:
RR greater than 30
PH between 7.25 and 7.35
What is the benefit of ICS in COPD?
To reduce the frequency of exacerbations
What are the GOLD stages of COPD?
Mild FEV1.0 80%
Very severe less than 30%