COPD Flashcards
(26 cards)
What is COPD
Chronic bronchitis
Emphysema
-productive cough more than 3 months of year for 2 consecutive years-
Does COPD cause clubbing
NO
What is the scale used for impact of COPD?
MRC Dyspnoea scale
Grade 1 – Breathless on strenuous exercise
Grade 2 – Breathless on walking up hill
Grade 3 – Breathless that slows walking on the flat
Grade 4 – Stop to catch their breath after walking 100 meters on the flat
Grade 5 – Unable to leave the house due to breathlessness
What does spirometry show?
Obstructive
FEV1/FVC ratio of <0.7
Non reversible
How is severity of COPD graded?
3-5-8- fibonacci (add on prev number
With FEV1 Stage 1: FEV1 >80% of predicted Stage 2: FEV1 50-79% of predicted Stage 3: FEV1 30-49% of predicted Stage 4: FEV1 <30% of predicted
What other investigations should be done in COPD?
Chest xray to exclude other pathology such as lung cancer.
Full blood count for polycythaemia or anaemia. Polycythaemia (raised haemoglobin) is a response to chronic hypoxia.
Body mass index (BMI) as a baseline to later assess weight loss (e.g. cancer or severe COPD) or weight gain (e.g. steroids).
Sputum culture to assess for chronic infections such as pseudomonas.
ECG and echocardiogram to assess heart function.
CT thorax for alternative diagnoses such as fibrosis, cancer or bronchiectasis.
Serum alpha-1 antitrypsin to look for alpha-1 antitrypsin deficiency. Deficiency leads to early onset and more severe disease.
Transfer factor for carbon monoxide (TLCO) is decreased in COPD. It can give an indication about the severity of the disease and may be increased in other conditions such as asthma.
What is non medical management of COPD?
Stop smoking
Pulmonary rehab training
Pneumococcal and flu vaccine
What is medical management of COPD?
- SABA/SAMA (ipatropium)
- If no asthma/steroid responsiveness- LABA and LAMA combination inhaler
- If positive asthma or steroid response then LABA and ICS “Fostair”, then stepped up to LABA LABA and ICS triple therapy
3 If severe nebs/oral theophylline/ carbocysteine/prophylactic azithro/O2 at home
What are indications for home O2?
Chronic hypoxia
Polycythaemia
Cyanosis
Heart failure secondary to cor pulmonae
What is seen on an ABG for COPD?
Acidosis if CO2 retention
Raised bicarb indicated they chronically retain CO2- if still acidotic is acute on chrnoic
What is ABG for type 1 resp failure
Normal pCO2 with low O2
only 1 affected
Raised CO2 and low PO2
Type 2
2 affected
What are issues with home O2?
Excessive O2 can depress resp drive slowing breathing and effort and leading to increased CO2 retention. If already retaining CO2 needs careful monitoring with ABGs and O2 sats
What masks are used in COPD O2
Venturi so that % controlled
What Sats aimed for in home O2?
88-92% if retaining
If not retaining >94%
How are exacerbations treated at home?
Pred 7-14 days
Nebs
ABX in infection
In hospital Neb bronchodilators Steroids (hydrocortisone/pred ABX Physio to clear sputum BIPAP Severe: IVE aminophylline NIV Intubate
What is cor pulmonae?
Fluid overload due to heart failure, oedema and RVH
What does alpha 1 antitrypsin deficiency cause?
Early onset
Worse prog
What does disease process of COPD include?
- Submucosal bronchial gland enlargement
- Goblet cell metaplasia
- Mucous hypersecretion
- Epithelial squamous metaplasia
- Ciliary dysfunction
- Hypertrophy of smooth muscle and connective tissue
- Progressive capillary bed obliteration
What are signs of CO2 retention?
Flap
Confusion
What are the 2 classic presentations of COPD?
Pink puffer- CO@ sensitive
Blue Bloated- hypoxia due to depressed resp drive, Cor pulmonae- CO2 resistant
What is spirometry explanation
Overall high tidal and residual volumes.
The expiratory limb of the flow volume loop is ‘scooped’ as mid expiratory flow is compromised as airways collapse
WHat are bacterial causes of exacerbations?
H influenzae
S. pneumonia
Moraxella catarrhalis
Which ABX used in exacerbation:
Amox
Doxy if allergic to pen
Co Amox if not responding
