COPD Flashcards
What is COPD?
non-reversible, long term deterioration in air flow through the lungs caused by damage to lung tissue
What is the main cause of COPD?
smoking
Does salbutamol reverse obstruction?
No - only do in asthma
Presentation of COPD
smoker
SOB, cough, sputum, wheeze, recurrent respiratory tract infections
other diagnoses to consider
lung cancer, heart failure and fibrosis
does COPD cause clubbing?
No
Does COPD cause haemoptysis or chest pain?
neither
5 point scale for breathlessness
1 = SOB strenuous exercise 2 = walking up hill 3 = SOB that slows walking on flat 4 = stop to catch breath after 100m on flat 5 = unable to leave house
diagnosing COPD
clinical picture and spirometry
FEV1/FVC ratio
<70%
severity of COPD based on FEV1
stage 1 = >80%
stage 2 = 50-79%
stage 3 = 30-49%
stage 4 = <30%
other investigations
CXR FBC - polycythaemia sputum culture ECG and echo CT thorax serum alpha 1 antitrypsin transfer factor for carbon monoxide
long term management
stop smoking pneumococcal and flu vaccine SABA or SAMA LABA and LAMA (anoro) LABA and ICS (fostair) LABA and LAMA and ICS (asthmatic features) - trimbo
Other management strategies
nebulisers - salbutamol/ipratropium oral theophylline oral mucolytic long term prophylactic antibiotics long term oxygen
Indications for long term oxygen therapy
chronic hypoxia
polycythaemia
cyanosis
heart failure secondary to pulmonary hypertension
what is heart failure secondary to pulmonary hypertension known as?
cor pulmonale
Important thing to remember with long term oxygen therapy
cannot be used if smoke - fire hazard
How does an exacerbation present?
acute worsening of symptoms - cough, SOB, sputum and wheeze
what triggers exacerbations?
usually viral or bacterial infection
exacerbation investigation
ABG
ABG - exacerbation
respiratory acidosis
raised bicarbonate = chronic retain co2 and kidneys responded
type 1 resp failure
low pO2 with normal pCO2
type 2 resp failure
pO2 and PCO2 low
Other investigations - exacerbation
CXR, FBC, U and E
ECG
sputum culture
blood cultures if septic
