COPD Flashcards Preview

OSCE > COPD > Flashcards

Flashcards in COPD Deck (13):
1

Definition

Irreversible progressive inflammatory airway obstruction disease. Usually caused by tobacco smoke exposure.

2

Aetiology

Tobacco
Occupational eg dust, gas, vapour, silica, coal.
Atmospheric pollution.
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.

3

Differentials

HF
Asthma
TB or other infection
Bronchiectasis
CF
Neoplasm
PE
Obliterative bronchiolitis
Obstructive sleep apnoea
Hypothyroid
Neuromuscular disease

4

Management

Oral steroid trial
Avoid tobacco and pollutants
Vaccines (flu and pneumococcal) or chronic AB.
Rehab, nutrition etc
Weight loss
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.
Transplant
AVOID high dose oxygen. Target pO2 88-92%.

5

Complications

Acute exacerbation eg ABs, infection.
Recurrent infection, pneumonia
Polycythaemia
Respiratory failure T2
Cor pulmonale due to pulmonary vasoconstriction and sm thickening- ankle swelling etc.
Pneumothorax
Lung CA

6

Symptoms

Cough usually worse in morning, chronic, productive
Sputum
Dyspnoea progressive
Wheeze with hyperventilation
Tachypnoea to compensate for hypoxia
NOT diurnal variation and NOT night waking

7

Signs

Tachypnoea
Accessory muscles, pursed lips
Hyperinflation
Increased cricosternal distance
Decreased expansion
Resonance
Quiet breath sounds over bullae
Wheeze
Cyanosis
Cor pulmonale
Flapping tremor

8

Diagnosis

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.

9

Pathological changes

Increase size mucous glands
Increase number goblet cells
Decreases cilia function
Elastin breakdown
Reduced surface area
Vascular change causes pulmonary HTN

10

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

11

Anticholinergic ADRs

-Local-
Dry mouth and cough
Sore throat
Pharyngitis
URTI
Bitter taste
Nausea
Glaucoma acute
-Systemic-
SVT, AF
Urinary difficulty and retention
Constipation

12

Steroid ADRs
CAB TO MI GP

Cataracts
Adrenal insufficiency
Bruising
Thin skin
OP
Mental disturbance
Increase weight
GI
Proximal myopathy

13

Explanation

-Chronic obstructive pulmonary disease is a progressive disorder where the airways in the lungs become damaged. It can either be because of too much mucous secretion or a loss of stretchiness of the air sacs in the lungs. Both of these things make it difficult to breathe in enough air. The damage is usually due to smoking but not always.
-generally symptoms get worse over months or years and you are able to less activity. In the LT this can put strain on your heart and can lead to HF, but treatment aim to avoid this. Can get sudden episodes of worsened SOB eg if you have an infection.
-stop smoking. Lose weight. Good nutrition. Controlled exercise.
-inhalers for if you feel it getting bad. Daily steroids. Home oxygen. ABs for infections. Occasionally surgery. Other drugs as well for the airways.