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Flashcards in RESP: COPD Deck (32)
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1
Q

How does a patient with COPD present? divide into symptoms and signs

A
Symptoms:
Productive cough sputum 
Wheeze
Dyspnoea
Reduced exercise tolerance
Signs :
Accessory muscle use
Tachypnoea
Hyperinflation
Reduced cricosternal distance
Reduced chest expansion
Hyper-resonant percussion
Decreased/quiet breath sounds
Wheeze
Cyanosis
Cor pulmonale (signs of right heart failure)
2
Q

what DDx should you consider when thinking about COPD

A
  • Lung cancer
  • Heart failure
  • lung fibrosis
  • asthma
  • bronchiecstasis
3
Q

What might you see on examination of a pt with COPD?

A
Tacchypnoea
Resp distress
accessory muscle use
intercostal retraction
barrel chest
wheezing 
coarse crackles
cyanosis 
Right sided heart failure (+ neck veins, heptatomegaly, LL oedema)
Asterexis -hypercapnia
4
Q

What are the most common bacterial organisms that cause infection exacerbations of COPD?

A

Haemophilus influenzae (most common cause)

Streptococcus pneumoniae

Moraxella catarrhalis

5
Q

What would you see on CXR with a patient with COPD?

A
  • Airway central
  • Breathing - hyperinflated lung fields with more than 6 anterior ribs seen on radiograph
  • bullae may be seen, almost mimicing a pneumothorax
  • cardiomegaly may be present
  • flattened hemidiaphragm
6
Q

What is type 1 respiratory failure?

A

Pa02<8kPa; PaC02 Normal

7
Q

Causes of type 1 respiratory failure?

A
Asthma 
Congestive HF 
Pulmonary Embolism 
Pneumonia 
Pneumothorax
8
Q

What is type 2 respiratory failure?

A

Pa02<8kPa; PaC02 > 6kPa

9
Q

Causes of type 2 respiratory failure?

A
  • Obstructive lung disease e.g. COPD
  • Restrictive lung disease e.g. IDL
  • Depression of respiratory centre e.g. opiates
  • NMJ disease e.g. Guillan barre syndrome, MND
  • Thoracic wall disease- rib fracture
  • Severe asthma
  • myasthenia gravis
  • Obsesity
    *
10
Q

What is pathophysiology of COPD?

A

Eemphysema and chronic bronchitis

Mucous gland (goblet cells) hyperplasia

Loss of cilial function

Emphysema – alveolar wall destruction causing
irreversible enlargement of air spaces distal to the
terminal bronchiole

Chronic inflammation (macrophages and
neutrophils) and fibrosis / remodelling of small airways
11
Q

What is the definition of COPD?

A

COPD is characterised by airflow obstruction. Airflow obstruction is progressive, not fully reversible and does not change markedly over several months.

The disease is predominantly caused by smoking

12
Q

What are the cuases of COPD?

A

Smoking

Inherited - α-1-antitrypsin deficiency

Industrial exposure - e.g. soot from coal or dust

13
Q

What is outpatient COPD Management?

A
  • ‘COPD Care Bundle’
  • SMOKING CESSATION
  • Pulmonary Rehabilitation
  • Bronchodilators
  • Antimuscarinics
  • Steroids
  • Mucolytics
  • Diet
  • LTOT if appropriate
  • Lung Volume reduction if appropriate
14
Q

What does the ‘COPD care Bundle’ involve?

A

Assessment of inhaler technique

Provision of a written patient self-management action plan

(where appropriate) an emergency drug pack

The offer of referral for support to stop smoking

Access to a treatment programme that can help people with a lung condition stay active (pulmonary rehabilitation)

Appropriate follow-up arrangements.

15
Q

Who is in the multidisciplinary team for COPD patient care?

A
Physicians 
GPs
specialist nurses
Physiotherapists
pharmacists 
Occupational therapsits 
Dieticians.
16
Q

What are the indications for long term oxygen therapy for a patient with COPD?

A

pO2 below 7.3 kPa, or 8 kPa (cor pulmonale)

Non-smokers

Balance loss of
independence/ reduced activity

Note: 02 not a treatment for breathlessness; to prevent organ hypoxia

17
Q

Why is long term oxygen therapy good for COPD patients?

A

Hypoxia can causes renal and cardiac damage - LTOT reduces this

18
Q

How long do COPD pts need to use long term oxygen therapy for a day to get a survival benefit ? (LTOT)

A

at least 16 hours a day

19
Q

What is pulmonary rehabilitation?

A

MDT 6-12 week programme:

  • supervised exercise
  • unsupervised home exercise
  • nutritional advice
  • disease education
20
Q

Why is pulmonary rehabilitation good for COPD pts?

A

COPD pts avoid exercise / physical activity as breathless.

Leads to vicious cycle of increasing social isolation, depression, muscle weakness and inactivity making symptoms worse

21
Q

How would you judge a pt with COPD to be in the midst of an infective exacerbation ?

A

Change in sputum volume / colour

Fever

Raised WCC +/- CRP

22
Q

How would you manage a pt with COPD who is having an exacerbation?

A

ABCDE approach

O2- aim for 94-98% but if evidence of (raised pCO2 on ABG) or Type 2 Resp Failure, then target SaO2 88-92%

NEBs – Salbutamol and Ipratropium

Steroids – Prednisolone 30mg STAT and OD for 7
days

Antibiotics if raised CRP / WCC or purulent sputum

CXR

Consider IV aminophylline

Non invasive ventilation if Type 2 respiratory failure and pH
7.25-7.35

pH <7.25 consider ITU referral

23
Q

Indication for LTOTs?

A

paO2<7.3
paO2<8 in cor pulmonale
Not smoking

24
Q

What is a restrictive pattern on spirometry?

A

FEV1:FVC ratio the same >0.7 but the FEV1:FVC values have decreased

25
Q

Which oxygen delivery device is commonly used in patients with COPD, and why?

A

Venturi masks are calibrated to deliver Fio2 between 24% and 50%, allowing Po2 to be titrated.

minimising the risk of CO2 retention (hypercarbia) associated with uncontrolled oxygen therapy

26
Q

How should beta-2 agonists be delivered in patients with hypercapnia, in the context of acute COPD exacerbation?

A

Use a nebuliser driven by compressed air rather than oxygen (to avoid worsening hypercapnia).

27
Q

Describe the management of acute COPD exacerbation if there is no response to an initial dose of a bronchodilator

A

Repeat doses of salbutamol at 15-30 minute intervals
Give continuous nebulised salbutamol at 5-10 mg/hour

28
Q

When are oral corticosteroids indicated in an acute exacerbation of COPD and what is the recommended prescription?

A

Consider oral corticosteroids for people with a significant increase in breathlessness that interferes with daily activities.
Offer 30mg oral prednisolone once daily for 5 days

29
Q

Describe the management of patients with acute COPD exacerbation that do not respond to first or second-line drug treatments

A

Escalate the patient’s care to senior medical staff to consider further management, including:

Non-invasive ventilation (NIV) for persistent hypercapnic respiratory failure.
Respiratory stimulants and intravenous theophylline.

30
Q

Describe the GOLD staging criteria

A

Used for staging COPD
4 categories based on the FEV1
Stage 1 is classed as an FEV1 >80%
Stage 2 50-79%,
Stage 3 30-49%
Stage 4 <30%.

see Geeky medics - COPD

31
Q

Name four complications of COPD

A

Cor pulmonale
Pneumothorax
Secondary polycythemia
Hypercapnic respiratory failure

Cor pulmonale is right-sided heart failure due to high pressure in the p

32
Q

Name three clinical signs associated with cor pulmonale

A
  • Distended neck veins
  • Hepatomegaly
  • Peripheral oedema

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