COPD Flashcards
What is COPD? Give features
Chronic Obstructive Pulmonary Disease
A SLOW progressive disease with little variation
(AFO that doesn’t change markedly over several months)
Most lung function impairment is fixed and irreversible
Made of emphysema and chronic bronchitis
What is emphysema? How is elasticity lost?
Hyperinflation of lung, destruction of lung tissue and elasticity with minimal fibrosis
Elasticity is lost by loss of alveolar attachments
What causes the AFO in COPD?
Excretions of mucus and exudates cause AFO
What is the aetiology of COPD?
Chronic asthma
Smoking
Occupational
Alpha1-antitrypsin deficieny
Do you have to be a smoker to get COPD?
No, can occur in people with antitrypsin deficiency or those who develop it from chronic asthma
What is alpha1-antitrypsin’s role?
Neutralises enzymes released by n.phils that destroy elastic tissue
What is a typical COPD patient? Age? Symptoms?
+40s
Smoker/Ex-Smoker
Dyspnoea of exertion
Cough - productive
What should be asked in a history?
PMH - Asthma as a child, any other resp diseases, ischaemic heart disease
Drugs - any inhalers and doses, previous meds and affects they had on breathing
Personal and social - Occupation, smoker
How are pack years calculated?
Packs smoked a day x years smoked
60 cigs a day (3 packs) x 23 years
= 69 pack years (so unintentional)
Symptoms of COPD?
Dyspnoea on exertion
Cough and sputum
Wheeze on exertion
Weight loss - indicator of severe disease
Peripheral oedema - indicator of severe disease and/or resp failure/ cor pulmonale
Signs on examination?
Pursed lip breathing Use of accessory muscles Hyperextended barrel chest - reduced exapnsion CO2 flap Cyanosis
What are some signs of cor pulmonale?
Increased JVP
Hepatomegaly (enlarged liver)
Ascities
Oedema
What investigations can be done?
Spirometry Full pulmonary testing Response to bronchodilators and ICSs CxR ECG Arterial blood gases
What will be seen in a spirometry test?
FEV1:FVC <70%
FEV1 <80%
If its normal rules out COPD
Why is full pulmonary testing done?
To look for presence and extent of emphysema
Why is patients response to ICSs and Bronchodilators tested?
If reversibility is shown - could be asthma
What will a CxR show up if it is COPD?
Hyperinflated lungs/chest
Flattened Diagrams
Bullae
What will an ECG show?
RA and RV hypertrophy - test for cor pulmonale
Why do a blood gas test?
Low PaO2 shows hypercapnea
Severity of COPD - Mild?
FEV1 still normal - above 80% but symptoms are getting worse, beginning of COPD
Moderate?
FEV1 - 50 - 79%
Severe?
FEV1 30-49%
Very severe?
FEV1 is less than 30%
What is some non-pharmalogical measures to manage COPD?
Smoking cessation
Pulmonary rehab
Vaccines
Long term O2 therapy
