Flashcards in COPD Deck (30)
What is the key difference between asthma and COPD?
Asthma is fully reversible obstruction whereas COPD is not
What is the FEV1/FVC in patients with COPD?
Always less than 0.7
COPD is graded in it's severity by what?
FEV1 starting at mild which is grade 1 which is less than 80%
What is grade 2 COPD
Moderate with an FEV1 of 50-79%
What is stage 3
Severe and there is a FEV of 30-49%
What is the 4th and final grade
Very severe accompanies an FEV1 of >30%
COPD is an umbrella for which two diseases?
Chronic bronchitis and emphysema
What other factors differentiate COPD from asthma?
COPD patients: over 35, persistent and productive cough, almost always caused by smoking, breathlessness progressive and persistant, no nocturnal symptoms unless severe, FMH uncommon, atopic co-conditions less likely
When can COPD appear at earlier ages?
In hereditary alpha 1 antitrypsin deficiency. (It is normally responsible for protecting connective tissue breakdown by neutrophil elastase)
What are the main pathological features of COPD?
Mucous hyperseceretion, tissue destruction, impaired repair and defence mechanisms causing small airway inflammation and fibrosis
What does the fibrosis and inflammation of the small airways lead to?
Increased resistance, reduced compliance, air trapping and progressive airway obstruction
What is emphysema?
Histologically enlarged air spaces distal to terminal bronchioles and destruction of alveolar walls reducing total surface area of the lungs for exchange
What is chronic bronchitis?
Cough and sputum production on most days of 3 months of a year for at least 2 consecutive years
Prevalence of COPD?
10-20% of over 40s
What are pink puffers? (Emphysema patients)
Patients with high alveolar ventilation, near normal PO2, normal or low PCO2, they are breathless but not cyanosed
What might pink puffers progress to?
Type 1 respiratory failure where there is hypoxia (PaO2 of
What are blue bloaters? (Chronic bronchitis)
Hypoxia, hypercapnic, high resp rate, raised Hb, oedema, cardiomegaly, use of accessory breathing muscles progresses to type 2 respiratory failure
With emphysema patients especially, (low PCO2) means breathing is driven by hypoxia therefore what should you be careful doing?
Giving oxygen as it may cause respiratory arrest
What are the signs of COPD?
Tachypnoea, use of accessory muscles, hyperinflation, decreased circosternal space, quiet breath sounds, cyanosis, cor pulmonale.
What is cor pulmonale
Right ventricular dilatation and consequent fluid retention as a result of increased resistance for blood entering the pulmonary circulation increasing after load
What investigations must be done?
Spirometry, ABGs, CXR, FBC (showing increased PCV and haemocrit of >55%), echocardiogram to confirm RV dilatation in cor pulomonale
What lifestyle advice and general help would you give to those with chronic COPD?
Smoking cessation, weight loss, influenza and pneumococcal vaccination,
What drug might you give as a general measure if required?
Short acting beta agonist and ipratropium bromide
If moderate give what?
Long acting anti-muscarinic (tiotropium) or beta 2 agonist
If severe give what?
Long acting beta agonist and corticosteroid
If the patient remains symptomatic after grade 3 treatment do what?
Give tiotropium, inhaled steroid, beta agonist and refer to specialist
Non smokers can receive what if symptoms persist and PO2 below 7.4
Long term oxygen therapy (LTOT)
Complications of COPD
Exacerbations, polycythemia, respiratory failure, cor pulmonale, pneumothorax, carcinoma
General steps for exacerbation of COPD are?
Nebulised bronchodilators, controlled O2 therapy aiming 88-92%, antibiotics, steroids