COPD

 

Disease:

Pathophysiology

·      Small airway swelling + mucus -> obstruction

·      Destruction of lung parenchyma -> emphysema

COPD complications

T1RF:

·      VQ mismatch

·      ↓PaO2

·      ±Pulmonary hypertension

·      ±Cor pulmonale

T2RF:

·      Hyperexpansion + gas trapping + dynamic airways compression

·      Inefficient ventilatory mechanics

·      ↑PaCO2

Other:

·      Apical bullae + IPPV -> pneumothorax

Smoking complications

Respiratory:

·      Airway hyperreactivity -> laryngospasm, bronchospasm

·      Carboxyhaemoglobinaemia -> ↓PaO2

·      Impaired mucociliary escalator -> pneumonia

Cardiovascular:

·      IHD

·      Stroke

Immunological:

·      Wound dehiscence

·      Wound infection

·      Pain

Haem:

·      VTE

 

Severity:

Spirometry:

1.      >80%

2.      50-80%

3.      30-50%

4.      <30%

Clinical:

 

Mild symptoms +

Severe symptoms

Infrequent, mild exacerbations

A

B

Frequent, severe exacerbations

C

D

 

Pre-op assessment:

Questions

·      Severity?

·      Optimisation?

·      Complications?

·      Airway reactivity?

Decisions:

·      Proceed vs cancel?

·      GA vs regional?

·      HDU vs ward?

History

Smoking:

·      Pack years

·      If quit, how long ago

·      Productive cough

COPD:

·      Severity: limitation, home O2

·      Exacerbations: frequency, hospitalisation, ICU

·      Treatment

·      Current status

Examination

·      General: barrel chest, WOB, ↑E-time, pursed lips, cyanosis

·      Vitals: SpO2

·      Resp: hyperinflated, decreased expansion, wheeze vs quiet

Investigations

·      PEFR

·      Spirometry

·      TTE

 

Treatments:

·        Stop smoking

·        SABA (salbutamol)

·        LAMA (tiotropium, glycopyrronium)

·        LABA (salmeterol, indacaterol)

·        ICS (fluticasone)

·        Surgery

 

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