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Flashcards in FN: COPD Deck (23):
1

Definition

Airway obstruction
Chronic bronchitis
Emphysema

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Airway obstruction

FEV1 <0.70

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Chronic bronchitis

cough and sputum production on most days for 3 months of 2 successive years

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Emphysema:

histological diagnosis of enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls.

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Causes


• Smoking
• Pollution
• Alpha1ATD – young age COPD + FH

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Symptoms

• Cough + sputum
• Dyspnoea
• Wheeze
• Wt. loss

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Signs

• Tachypnoea
• Prolonged expiratory phase
• Hyperinflation
→ Reduced cricosternal distance
→ Loss of cardiac dullness
→ Displaced liver edge
• Wheeze
• May have early-inspiratory crackles
• Cyanosis
• Cor pulmonale: raised JVP, oedema, loud P2
• Signs of steroid use

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Pink Puffers

Emphysema
• Raised alveolar ventilation → breathless but no cyanosed
• Normal or near normal PaO2
• Normal of low PaCO2
• Progress → T1 respiratory failure

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Blue Bloaters

Chronic Bronchitis
• Reduced alveolar ventilation → cyanosed but not breathlessness
• Reduced PaO2 and raised PaCO2: rely on hypoxic drive
• Progress → T2 respiratory failure and cor pulmonale

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Complications

Acute exacerbations ±infection
Polycythaemia
Pneumothorax (reuptured bullae)
Cor pulmonale
Lung carcinoma

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Treatments →

General

Mucolytic:

Breathlessness and/or exercise limitation

Exacerbations or persistent breathlessness

Persistent exacerbations or breathlessness
LTOT (long term oxygen therapy)
Surgery

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General





1. Stop smoking
a. Specialist nurse
b. Nicotine replacement therapy
c. Bupoprion, varenicline (partial nicotineagonist)
d. Support programme
2. Pulmonary rehab
3. Treat poor nutrition and obesity
4. Manage comorbidities e.g. cardiovasc, lung cancer, osteoporosis
5. Influenza and pneumococcal vaccine

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Mucolytic:

Carbocisteine

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Breathlessness and/or exercise limitation

• SABA and/or SAMA (ipratropium) PRN
• SABA PRN may continue at all stages

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Exacerbations or persistent breathlessness

• FEV >50% LABA or LAMA (tiptropium)
• FEV1<50% LABA + ICS combo or LAMA

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Persistent exacerbations or breathlessness


o (PDIs) may be considered
Consider home nebs

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LTOT (long term oxygen therapy)

PaO2 >8 for >15h/day (increased survival by 50%)

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Surgery

Recurrent penumothoraces
Isolated bullous disease
Lung volume reduction

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Bloods show

• FBC (polycythaemia)
• Alpha1-AT level
• ABG

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CXR

• Hyperinflation (>6 ribs anteriorly)
• Prominent pulmonary arteries
• Peripheral oligaemia
• Bullae

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ECG

• R atrial hypertrophy: P Pulmonale
• RVH, RAD

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Spirometry

• FEV1 <0.70
• Raised TLC
• Raised RV

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Echo

• PHT

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