What are the causes of exacerbations of COPD?
Infective (doesn't include pneumonia)
What are some physical signs of COPD?
Hyperresonance to purcussion
Dull breath sounds
A progressive condition of irreversible airflow limitation due to an ongoing, abnormal inflammatory response to noxious stimuli
Describe the epidemiology of COPD
3rd leading cause of disease burden in Aus
500,000 Australians have moderate COPD
Describe 4 microscopic aspects of the COPD pathophysiology
Destruction of alveolar septa
Loss of elasticity
Inflammatory cell infiltrate - Neutrophils, macrophages, CD8+
Destruction of pulmonary capillary bed
How do you make the diagnosis of COPD?
By what factor is FER reduced for COPD to be diagnosed?
(FER = FEV1 / FVC)
Why might FVC be low in COPD lungs?
What is chronic bronchitis?
Inhalation of a noxious stimulus that causes production of mucus chronically
In which airways does inflammation generally occur? What is the consequence?
Fibrosis and obliterative bronchiolitis
What are some long acting beta2 agonists used in COPD?
Indacaterol (ultra long acting)
Name some anticholinergics used in COPD?
What is the mechanism of action of tiotropium (spiriva)
It's an anticholinergic - Blocks M3 muscarinic receptors on smooth muscle cells and submucosal glands to reduce bronchocontriction and mucus secretion
What are some side effects of anticholinergics?
When are inhaled corticosteroids indicated in COPD?
GOLD Criteria Stage III and IV
(III - FEV1 = 30-50% predicted)
Incombination with LABA
What is seratide a combination of?
Salmeterol and fluticasone
What is pulmonary rehabilitation?
Patients develop mastery of their airways
What is the benefit of oxygen home therapy?
Reduces pulmonary hypertension
Why does lung reduction surgery help in COPD?
Bad lung impinges on good lung
What therapies can be used in exacerbations?
How do you approach the Ix and Mx of IECOPD?
- FBE, UEC
- Blood culture
- O2, aim sats 88-92% (if CO2 retainer)
- Bronchodilators - Salbutamol, up to 12 puffs prn, Ipatropium up to 5 buffs
- Steroids - Pred ~50mg, 3d
- Antibiotics - oral doxycycline/amoxicillin
Clinically, what defines an exacerbation of COPD?
Change in cough
Change in character of sputum
Increase in dyspnoea
What is the casade of treatment for COPD
Gold 1 (FEV1 >80%) Short acting beta-agonist
Gold 2 (50-80%) SABA and LAMA
Gold 3 (30-50%) SABA, LAMA, consider inhaled corticoid steroid/LABA
Gold 4 (<30) Consider Oral steroids, Home O2, and Surgical reduction of the lung
How is chronic bronchitis diagnosed?
Chronic cough for most days of the weeks for 3 months of the a year
What does COPDX stand for?
Optimise lung function
Develop support network
X - prevent exacerbations