COPD OSCE

Clinical manifestation
-chronic, air-hunger, gasping for air (chronic dyspnea!!) prominent!!
-dyspnea not improve with rest/activities or change of position (DD with heart failure type dyspnea)
-cough throughout the day, productive cough (sering batuk)
- wheezing
-prolonged expiratory compare to inspiratory (>4s)
-barrel chest
-pursing lips
-use of accessory respiratory muscle
-low exercise tolerance
-risk factor for pneumonia
-main complication: right heart failure (note for its S&S)
Note: in chronic COPD but with acute exacerbation, the S&S of patient would follow the
exacerbation disease eg. Pneumonia S&S!! (eg auscultation sound would be ronchi basah kasar
<indicative infection> instead of decrease vesicular)

Risk
-history of smoking (long term)
-occupational dusk, cooking smoke
->35 years old

Physical Examination
General
-JVP increase (RHF)
-respiratory rate increase
-cyanosis and clubbing fingerchronic hypoxia
-peripheral edema
Inspection
-barrel chest
-paradoxical in drawing of lower coastalalveolar collapse
Palpation
-low fremitus
-diaphragm expansion (left and right)not fully but symmetry
Percussion
-hyperesonant
-diaphragm percussion no cranio-caudal expansion
Auscultation
-vesicular weaken

Supporting examination
-Gold: spirometry (not do in acute exacerbation)
-Bronchodilator reversibility testrule out asthma
Treatment
Bronchodilator and glucocorticoid

Education
-stop smoking
-avoid exposure

Reference

Tx:
-If hypercapnia, titrate SpO2 at 88-90%
-Influenza vaccine (Evidence A), Pneumococccal vaccine (Evidence B)
-Bronchodilators:
1) Beta2-agonists
>short-acting: Fenoterol, Salbutamol (albuterol), Terbutaline
>long-acting: Formoterol, Salmeterol
2) Anticholinergics
>short-acting: Ipratropium bromide, Oxitropium bromide
>long-acting: Tiotropium
3) Methylxanthines (toxic, no benefit)
>Aminophylline, Theophylline

Tx for exacerbations:
-Bronchodilator, glucocorticoids
-Antibiotics if infection (sputum increase, fever)
-O2
-Mechanical ventilation