15 COPD Flashcards
What is COPD?
Chronic obstructive pulmonary disease
Not fully reversible, progressive
- Emphysema
- Chronic bronchitis
Inflammatory response to noxious particles or gases- primarily cigarette smoke
Apart from cigarette smoke (90% cases) , what are some other causes of COPD?
- Air pollution (developing countries)
- Occupational exposure
- Alpha-1 antitrypsin deficiency
- (alpha-1 antitrypsin= antiproteinase so destruction of alveolar walls)
- Not reaching full lung capacity in childhood?
Outline the pathophysiology of COPD
How do the changes that occur as a result of COPD lead to increased airway resistance?
What complications can be caused by COPD?
-
Cor pulmonae (right side hear failure)
- Progressive hypoxia
- Pulmonary vasoconstriction due to V/Q imbalance
- Pulmonary hypertension
- Vascular smooth muscle thickening
- Oedema
- Vascular smooth muscle thickening
- Pulmonary hypertension
- Pulmonary vasoconstriction due to V/Q imbalance
- Progressive hypoxia
- Recurrent pneumonia
- Respiratory failure
- Pneumothorax: lung tissue damage- rupture
The initial symptom of COPD is a cough. Describe the cough.
Frequently - morning cough
..then constant cough as disease progresses
Productive
Apart from a cough, how else will a patient with COPD present?
History?
Older person, History of smoking
Initial symtoms?
Shortness of breath
Productive cough
Physical examination?
Tachypnoea
Accessory muscle use (SCM, pectoralis major and minor, serratus anterior, latissimus dorsi, and serratus posterior superior)
Barrel chest
Hyper-resonance on percussion
Reduced intensity (distance breath sounds)
Wheezing
Late features?
Central cyanosis
Flapping tremors (CO2 retention)
Right sided heart failure ( distended neck veins, hepatomegaly, ankle oedema)
What investigations should be carried out for suspected COPD?
How is COPD treated?
Conservative
Stop smoking
Pneumococcal vaccination
Monitor patient: weight, nutrition status, physical activity
Pulmonary rehabilitation
Strengthen muscles, disease education, nutritional advice
Pharmacological
Bronchodilators
Inhaled corticosteroids
Long-term oxygen treatment
Surgical
Removal of large bullae (fluid filled sac)
Lung volume reduction
Lung transplant
What is an acute exacerbation of COPD? How will it present?
Event characterised by change in patients baseline dyspnoea/ cough/sputum beyound normal day to day variations and acute onset
PRESENTATION
- acute, severe shortness of breath
- fever
- chest pain
How are acute exacerbations of COPD managed?
How does someones FEV1 change with age?
A patient presents with dyspnea. How can we quantify this?
What are the risk factors for acute exacerbations of COPD?
If a patient is admitted to hospital with an acute exacerbation of COPD, what is there chance of being readmitted within 3 months?
43% in 3 months
