Signs+symptoms/diagnosis
List the signs/symptoms of acute COPD exacerbation
- Persistent cough
- SOB
- Wheeze
- Mucus production
What receptors does salbutamol work on and how does it work?
Beta-2 adrenergic agonist, relaxes airway smooth muscles by stimulating beta-2 receptors, leading to rapid bronchodilation
short acting
What are the two main lung diseases that come under the umbrella of COPD?
- Emphysema
- Chronic Bronchitis
What is the most significant risk factor for COPD
cigarette smoking
What clinical signs indicate increasing work of breathing in a COPD patient?
Accessory muscle use, tachypnoea, pursed-lip breathing, tripod positioning.
List common infectious and non-infectious triggers for COPD exacerbations.
Infectious: Viral URTI, bacterial pneumonia
Non‑infectious: Air pollution and medication non-compliance
Bonus (heart failure, PE)
What is the best way for a patient to inhale their MDIs
Via a spacer (and mask if required)
What type of respiratory failure is a CO2 retainer
Type 2 Respiratory Failure
What acid-base imbalance is most commonly seen during an acute COPD exacerbation?
Respiratory acidosis due to CO2 retention
Why is a decreasing respiratory rate concerning?
Suggests fatigue and loss of compensatory drive.
What arterial blood gas findings are typically seen in chronic compensated COPD?
Elevated CO2, elevated bicarbonate, and near-normal or slightly low pH.
What physiological position can help relieve dyspnoea in a patient with COPD, and explain how it improves breathing?
The tripod position helps improve chest/ diaphragm expansion, reduces WOB, improves air exchange
What is the target 02 level for CO2 retainers and why?
88-92% to prevent over-oxygenation which can worsen retention
What are the signs of infective exacerbation of COPD?
Increased SOB
Productive cough
Increased sputum production (yellow)
Fever
Increase Flow
Why are accessory muscles used when there is an increased in WOB?
To help aid breathing because lung hyperinflation and trapped air cause flattened diaphragm and intercostal muscles
What is the primary function of bronchodilators?
Relax the smooth muscles surrounding the bronchi and bronchioles
What mechanisms explain oxygen-induced hypercapnia?
Loss of hypoxic pulmonary vasoconstriction V/Q mismatch
Reduced hypoxic respiratory drive
List two signs that indicate a COPD patient may be deteriorating and require urgent intervention.
Altered level of consciousness, worsening hypoxia, rising CO2 levels, severe dyspnoea, or use of accessory muscles.
what are some signs of impending respiratory arrest?
Altered consciousness, silent chest, paradoxical breathing, bradycardia.
Indicates exhaustion rather than recovery.
Explain the pathological changes that define COPD and lead to airflow limitation?
Chronic airway inflammation, mucus hypersecretion, airway remodeling, and destruction of alveolar walls leading to loss of elastic recoil.
Name one long-acting muscarinic antagonist (LAMA) and its function.
Tiotropium/spiriva: it blocks muscarinic receptors, leading to bronchodilation and reduced mucus secretion.
How does CO₂ retention affect consciousness?
Causes cerebral vasodilation decrease brain perfusion leading to drowsiness, confusion, coma.
Aka CO₂ narcosis.
What is hyperinflation in COPD
When lungs expand beyond their usual size due to air being trapped inside.
When should ICU referral occur?
Severe acidosis, NIV failure, haemodynamic instability, reduced consciousness.