Condition Info - BotMed Application

ConditionName

COPD (Chronic Obstructive Pulmonary Disease; Emphysema)

ConditionDescription

Terminal airway destruction resolution in decreasing elastic recoil of lungs

Symptoms

Not inflammatory condition
Chronic productive cough
Anxiety
Acute: worsening dyspnea, increase in sputum purulence, increase in sputum volume

Recurrent resp. infections, dyspnea improving with rest, SOB, wheezing, rhonchi; Productive cough;
Morning headache; 
Cor pulmonale

Initially symptoms only on exertion 

Dyspnea; SOB; Productive cough; Wheezing; Rhonchi;
Morning headache;

PhysicalFindings

Clubbing, barrel chest, tachypnea, distant breath sounds
“Barrel chest”; Time of exploration 2 bigger time of inspiration 
Pursed-lip breathing;
Prolong expiratory duration;
Decreased heart sounds;
Decreased breath sounds;
Accessory muscle use;

Acute: fever, increased wheezing or cough, increased respiratory rate and heart rate.

JVD;

ClinicalTests

spirometry: airflow obstruction with emphysema

Best initial test: xRay: Increased AP diameter
Air trapping, flattened diaphragms

Most accurate test:  PFT. ↓FEV1 and FVC
FEV1/FVC <70%
TLC increase

ABG:
↓O2;
↑CO2;

ECG; Echocardiography; 

Albuterol doesn’t normalize spirometry result 
COPD staging:
GOLD1-FEV1>80 (mild)
GOLD2-FEV1 50-80 (moderate)
GOLD3-FEV1 30-50(severe)
GOLD4-FEV1 <30(very severe)
Decrease of FEV1 and FVC with increase in TLC

Not respond to bronchodilator

RiskFactors

Tobacco smoking (40 pack/year)
Young: alpha-1 antitrypsin deficiency b/c of degradation of elastase
Environmental exposure

IsRedFlag

IsNPLEX

Consequence

Pulmonary hypertension; Cardiac conditions; Cor Pulmonary 

R. atrial and R. ventricle hypertrophy
A-fib or multifocal arterial tachycardia (MAT)

Secondary viral infections.
Bacterial infections: Strep. Pneu, H. influenza, Moraxella catarrhalis

Acute exacerbation of COPD are associated with increase CO2 and hypoxia

Anxiety;

Terminal airway destruction resolution in decreasing elastic recoil of lungs;
Lung cancer;

ProgressionFromCondition

TreatmentOptions

To improve mortality and delay progression:
STOP SMOKING! 
More effective than any others intervention 
Oxygen therapy for hypoxia. Use it only to increase O2 up to 90% oxygen saturation
Indications for home O2:
Pulse-ox <88%
Pulmonary HTN
Peripheral edema
Polycythemia

PharmOptions

Symptoms control:
SABA or LABA with some degree of reversibility

Respiratory acidosis with incomplete compensation of metabolic alkalosis 

When nothing works: lung transplantation

Antibiotics to treat secondary infections (if SOB, sputum production or sputum purulence increases from the baseline)

WebLink

https://www.merckmanuals.com/en-ca/professional/pulmonary-disorders/chronic-obstructive-pulmonary-disease-and-related-disorders/chronic-obstructive-pulmonary-disease-copd?query=copd