A 65 year old woman with chronic airways disease presents with acute respiratory failure.
Outline how you would determine the severity of her underlying airways disease.
History: consider – exercise tolerance; ADLs; home O2 use; home CPAP/NIV use; respiratory medication use and compliance; steroid use; need for heart failure medication; frequency of hospitalisations or previous mechanical ventilation.
Examination: consider – steroid skin; cachexia / nutritional assessment; plethora secondary to polycythaemia.
Investigations: consider – previous ABGs (degree of hypoxaemia/hypercapnoea/metabolic compensation); Electrolytes: especially tCO2 indicative of bicarbonate compensation of chronic hypercapnoea; previous spirometry (FEV1/FVC - degree of emphysema/hyperexpansion/evidence of left or right heart failure); formal Pulmonary Function Tests (DLCO/flow-vol loops); ECG (?chronic right heart strain pattern); Hb (polycythaemia secondary to chronic hypoxaemia).
This question asks about the assessment of the severity of COPD.
- exercise tolerance
- breathlessness with everyday activities
- presence of chronic cough
- high volume of sputum, suggestive of bronchiectasis
- haemoptysis, suggestive of malignancy
- home O2 requirement
- home CPAP requirement
- pattern of bronchodilator use
- pattern of steroid use
- frequency of hospitalisations
- previous mechanical ventilation
- anorexia and weight loss
- features of malnutrition
- features of obesity (sedentary lifestyle)
- features of chronic steroid use
- central cyanosis
- breathlessness at rest
- hyperexpanded chest
- degree of air entry
- signs of right heart failure
- Bicarbonate levels
- Hb (polycythaemia)
- Spirometry, pre and post bronchodilator
- Formal lung function tests
- ABGs to determine degree of hypoxia and hypercapnea
- TTE (pulmonary pressures)
- High-resolution CT to assess the severity of emphysematous changes
Siafakas, N. M., et al. "Optimal assessment and management of chronic obstructive pulmonary disease (COPD)." European Respiratory Journal 8.8 (1995): 1398-1420.