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.
Siafakas, N. M., et al. "Optimal assessment and management of chronic obstructive pulmonary disease (COPD)." European Respiratory Journal 8.8 (1995): 1398-1420.