Flashcards in COPD Deck (13):
Irreversible progressive inflammatory airway obstruction disease. Usually caused by tobacco smoke exposure.
Occupational eg dust, gas, vapour, silica, coal.
Alpha1 antiT deficiency.
Chronic bronchitis- obstruction small airways dye to mucous hypersecretion, productive cough over 3 months for more than 2 successive years. Reduced recoil and air trapping.
Emphysema- loss elastin in alveoli, destruction of parenchyma, enlargement of air spaces, bronchioles narrowing.
TB or other infection
Obstructive sleep apnoea
Oral steroid trial
Avoid tobacco and pollutants
Vaccines (flu and pneumococcal) or chronic AB.
Rehab, nutrition etc
SABA or anticholinergic, then inhaled CS, then oral CS.
Supplemental O, sometimes LTOT if pO2 consistently under 7.3 or 8 with cor pulmonale.
Mucolytics eg carbocysteine
Methyxanthines eg theophylline inhibit Pdiesterase= increase cAMP, but risk SVT, nausea and seizure.
Lung volume reduction surgery rare.
AVOID high dose oxygen. Target pO2 88-92%.
Acute exacerbation eg ABs, infection.
Recurrent infection, pneumonia
Respiratory failure T2
Cor pulmonale due to pulmonary vasoconstriction and sm thickening- ankle swelling etc.
Cough usually worse in morning, chronic, productive
Wheeze with hyperventilation
Tachypnoea to compensate for hypoxia
NOT diurnal variation and NOT night waking
Accessory muscles, pursed lips
Increased cricosternal distance
Quiet breath sounds over bullae
CXR hyperinflation, flat hemidiaphragms, bullae, large central pulmonary arteries.
ECG RVH if cor pulmonale.
Function- obstructive pattern. FEV1/FVC under 70%, FEV1 under 80%.
ABG- hypoxia and hypercapnia maybe.
A1 antiT blood test in young patient.
High resolution CT.
Increase size mucous glands
Increase number goblet cells
Decreases cilia function
Reduced surface area
Vascular change causes pulmonary HTN
MRC dyspnoea score
1-SOB on strenuous exercise
2-SOB when hurry or incline
3-walk slower on level ground due to SOB, or has to stop
4-stops after 100m walking or a few mins on level ground
5-SOB on basic tasks
Dry mouth and cough
Urinary difficulty and retention
CAB TO MI GP