COPD and exacerbations Flashcards
Define COPD.
Progressive, non reversible obstructive pulmonary disease
What are the 2 diseases associated with COPD?Give definitions of each.
Emphysema: destruction of alveoli, resulting in decrease O2 exchange (pathological Dx but do not usually take biopsy)Chronic bronchitis: excessive production of mucus with daily productive cough of >/= 3 months for 2 consecutive years (clinical Dx)
What are the presenting features of COPD?
Productive coughSOBProgressive dyspnoea on exertionWheezingHx smoking
What are the main features of the Px?
NB: Px is generally a poor indicator unless in COPD exacerbationCyanosisIncrease JVP (if CHF)Barrel chest due to air trappingHyperresonanceProlonged expiration
What lung function test value is indicative of COPD?
FEV1/FVC
What are the DDx of COPD?
a. Asthma: COPD is not reversible by bronchodilatorb. a-1 anti-trypsin deficiency: always think of this if patient is not a chronic smoker,
What Ix should take place in Dx COPD?
Lung function testsABGsCXRECG
How do we manage COPD?
Increase survival rate:1. Smoking cessation * most important (legal requirement to advise on medical notes)2. Supplemental home O2 therapy (
What are the three things that should not be administered to a patient with COPD?
Expectorants (induces cough) or mucolytics - always will have mucus prod’n and will just be replacedCough suppressants - pts need to be able to cough up mucus
What should you admit a patient with COPD?
- Worsening saturation (
Define COPD exacerbation.
= acute worsening of Sx brought on by infection, CHF, air pollution, idiopathic factor
What are the DDx of COPD exacerbation?
a. PE: in PE there is continuous deterioration that is non-responsive to LABA and supplemental O2; prothrombotic RF should also be present *do CT scanb. Pulmonary oedema: CXR displays generalised lung opacity
How should you manage a pt with COPD exacerbation?
To decrease mortality:1. supplemental O2 to maintain >/= 90%To decrease symptoms:2. Inhaled B agonist (increase dose)3. PO corticosteroids (cf. inhaled normally)4. Broad spectrum Abx5. Pulmonary hygiene (suction of airways, physio) to clear mucus+ pneumococcal and flu vaccine
If O2 cannot be maintained at 90% during management what are the options for O2 delivery?
Options for O2 delivery depend on if it is getting to 90% (move down list if not reaching sats):a. Nasal prongs or maskb. Non invasive positive pressure vent (CPAP, BiPAP)c. Mechanical ventilation
What are the symptoms of prolonged corticosteroid use?
Cushing’s syndrome = clinical state produced by chronic glucocorticoid excess (chiefly caused by oral steroids)* Symptoms: - increase weight- mood change: depression, lethargy, irritability, psychosis- proximal weakness (ask them if they have trouble putting out washing, getting up out of chair)- gonadal dysfunction (irregular menses, hirsutism, erectile dysfunction)- acne- recurrent Achilles tendon rupture
What are the signs of prolonged corticosteroid use?
*Signs:- Central obesity- Plethoric - Moon face- Buffalo neck hump- Supraclavicular fat distribution- Skin and muscle atrophy- Bruises- Purple , abdo striae- Osteoporosis- BP increased- Glucose increased - Infection prone- Poor healing
Define COPD.
Progressive, irreversible obstructive pulmonary disease
Clinical Features of COPD
Productive coughDyspnoeaDecreased exercise toleranceWheezing
Signs of COPD
NB: Px is generally a poor indicator unless in COPD exacerbation, depends on severity of underlying disease:- Raised RR- Hyperexanded/barrel chest- Prolonged expiratory time > 5 seconds, with pursed lip breathing- Use of accessory muscles- Quiet breath sounds (esp in lung apices)- Quiet heart sounds (due to overlying hyperinflated lung)- Hyperresonance- Possible basal crepitations- Signs of cor pulmonale and CO2 retention (ankle oedema, raised JVP, warm peripheries, plethoric conjunctivae, bounding pulse, polycythaemia)- CO2 narcosis if Co2 acutely raised
DDx of COPD
a. Asthma: COPD is not reversible by bronchodilatorb.
Ix and results of COPD
A. Lung function tests:- obstructive spirometry and flow-volume loops- reduced FEV1 to 7 posterior ribs seen- Flattened diaphragm - More horizontal ribs- May see bullae, esp at lung apices
Management of COPD
Increase survival rate:1. Smoking cessation * most important (legal requirement to advise on medical notes)2. Supplemental home O2 therapy (
What are the signs of prolonged corticosteroid use?
*Signs:- Central obesity- Plethoric - Moon face- Buffalo neck hump- Supraclavicular fat distribution- Skin and muscle atrophy- Bruises- Purple , abdo striae- Osteoporosis- BP increased- Glucose increased - Infection prone- Poor healing
Aetiology of COPD
a. Smoking: 95% - smoking related (typically > 20 pack years); it occurs in 10-20% of smokersb. a1 - antitrypsin deficiency - AR inherited condition ass with early emphysema; a1-AT is a glycoprotein protease inhibitor produced by liver that opposes neutrophil elastase that destroys alveolar wall tissue
