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COPD and Asthma Dr Dillon Vyas OCTOBER 9TH 2021 18:30 @BRITISHINDIANMEDICASSOCIATIONDIANMEDICS @BIMA BIMA Clinical Crash CourseCOPD ● Non-reversible airway obstruction ● Inflammation of bronchioles ● Chronic bronchitis: productive cough for atleast 3 months in 2 consecutive years. ● EmphysemaPack year ● 20/day for 1 yearInvestigations ● Sputum culture ● ABG ● Bloods ● CXR ● SpirometryABG ● pH: 7.21 (7.35-7.45) ● pO2: 7.2 (10–14) ● pCO2: 8.5 (4.5–6.0) ● HCO3: 29 (22-26) ● BE: +4 (-2 to +2)Henderson-Hasselback equation ● CO + H O <-> H CO <-> H + HCO- 2 2 2 3 3 ● CO2is controlled by the lungs ● H and HCO3is controlled by the kidneys ● In COPD patients can have ventilatory failure 2nd retain CO leading to a respiratory acidosis ● T1RF: hypoxia but no hypercapnia ● T2RF: hypoxia with hypercapniaABG ● pH: 7.36 (7.35-7.45) ● pO2: 8.0 (10–14) ● pCO2: 7.6 (4.5–6.0) ● HCO3: 31 (22-26) ● BE: +5 (-2 to +2)Why do some COPD patients retain CO ? 21) Hypoxic drive ● Central chemoreceptors are sensitive to CO which induces the drive to breathe off the CO 2 2 ● Peripheral chemoreceptors are sen2itive to O and hypoxia induces the drive ● In healthy individuals the central chemoreceptors work more than the peripheral chemoreceptors in respiratory ● In COPD patients, they chronically have2a raised CO so their central chemoreceptors becom2 less sensitive to rising CO and the peripheral chemoreceptors play a bigger role in the respiratory drive2) Haldane effect ● Bohr effect: tissue where there is a high co2centration of CO and H , o2yhaemoglobin releases O . ● Haldane effect: lungs where there is a high concentration of O , carboxyhaemoglobin releases CO 2 2 ● COPD patients can’t increase their minute ventilation ● Minute ventilation = tidal volume x rr ● COPD patients can’t expire the 2xcess CO3) VQ mismatch and shunting● Alveoli which are poorly ventilated will undergo hypoxic pulmonary vasoconstriction. ● If we oxygenate the blood, it will reverse this process. ● Poorly ventilated alveoli will start getting pulmonary blood flow ● COPD patients have ventilatory failure. ● Increasing dead spaceManagement ● COSICAt ● Controlled oxygen ● Salbutamol ● Ipratropium bromide ● Corticosteroids ● AbxControlled oxygenComplications of COPD ● T2RF ● Polycythaemia ● Cor Pulmonale ● Bronchiectasis ● Osteoporosis ● DepressionLong term management of COPD ● Step 1: SABA or SAMA ● Step 2 no asthma features: LABA and LAMA ● Step 2 asthma features: LABA and ICS ● Step 3: LABA and LAMA and ICSAsthma ● Airway hyperresponsiveness – various triggers for bronchial smooth muscle contraction ● Bronchial inflammation – immune cell infiltration causing oedema, smooth muscle hypertrophy, mucus plugging, epithelial damage ● Airflow limitation – reversible.Management ● Oh SHIT Me ● Oxygen ● Salbutamol ● Hydrocortisone ● Ipratropium ● Theophylline ● Magnesium sulphateLong term Asthma management ladder ● Step 1: SABA prn ● Step 2: add low dose ICS ● Step 3: add LABA ● Step 4: LTRA or increase ICS dose ● Step 5: regular prednisolone and specialist referralAsthma Diurnal variation in symptoms and peak flow Atopy Eosinophilia Reversible obstruction Bronchiectasis Large volume of sputum Frequent LRTI High resolution CT: signet ring pattern CCF Orthopnoea, PND, CVD Fine basal inspiratory crepitations Raised BNP Echo: reduced EF Lung cancer Weight loss Haemoptysis CXR and bronchoscopy for biopsy TB Night sweats Weight loss Positive sputum MC+S BREAK Feedback form: BIMA Clinical Crash CourseTHANK YOU FOR LISTENING ANY QUESTIONS BIMA Clinical Crash CourseECG Imaging and Labs series PART 1 & 2 Dr Danial Naqvi OCTOBER 9TH 2021 18:30 @BRITISHINDIANMEDICASSOCIATIONNDIANMEDICS @BIMA BIMA Clinical Crash Course