Unit 8: Smoking and COPD Flashcards
What is meant by hyperinflation of the lungs?
When air gets trapped in the lungs causing the alveoli to remain inflated, reduces the patient ability to create a negative pressure for inspiration.
Often caused by limited airflow or decrease elastic content of the alveoli
What are the cardiovascular effects os smoking on the body?
- increases the formation of plaque in the bv
- nicotine stimulates the adrenal gland leads to adrenalin release resulting in increase HR and BP
- increase blood glucose by reducing cell response to insulin, damage blood vessels
- carbon monoxide, decrease oxygen transport, can increase risk of anemia, activate sympathetic nervous system by baroreceptors
What are the effects of smoking on the respiratory system?
- damage cilia and impair coordination of mucociliary esculator
- increased risk of pneumothorax (alveolar rupture from hyperinflation)
- inflammatory damage - constriction of airway and potentially sqaoumous cell metaplasia
- mucus production
-lung cancer (benzene, arsenic) - trigger an asthma attack
Passive: 50% increase in childhood asthma.
What are the effects of nicotine in the brain?
Nicotinic acetylcholine receptors located in the brain (voltage gated sodium ion channels)
Absorbed into the blood stream in the lungs
Affects the reward pathway
Triggers dopmaine release in the brain
However, repetitice stimulation hijacks the reward pathway to cause addiction by increasing baseline of dopmaine required to feel pleasant.
Tolerance due to increase in the nicotine receptors (desensitized).
These brain changes are reversible.
What is COPD?
Chronic Obstructive Pulmonary Disease
Present in 1.1 million people in England
Umbrella term for multiple degenerative lung conditions including emphysema and bronchitis.
Higher prevelance in older or middle aged smokers
What is bronchitis?
Results from an inflammatory response in the lungs
Goblet cells hyper secrete mucus in the bronchi (worsend by damage to cilia so struggle to clear mucus), this restricts the airway by a mucus plug
This increases resistance to air flow.
Hypertrophy and hyperplasia of mucus cells at consequence of cilliated cells - obstruction
Increased thickness of smooth muscle
What is emphysema?
Alveolar damage
Inflammation from smoking results in increases proteases (more than healthy anti-proteases).
Neutrophil elastase destroys alveolar attachments and elastin - reduced SA for exchange and causes collapse of bronchioles.
This compliance of the alveoli increases as reduced elastic recoil so can become hyperinflated and may rupture
What exams do we use to look at the respiratory system?
Pulmonary lung function tests - most common in spirometry, lung volumes and difussion capacity (safe dose CO into lungs, measure proportion in blood)
Chest x-ray
How do we diagnose COPD?
Aged over 35yrs with a smoking history and presenting symptoms
Spirometry FEV1/FVC ratio below 0.7
Chest X-ray or CT scan showing hyperexpansion of emphysema
What are the different treatement for COPD?
- offer support to stop smoking
- offer pneumococcal and influenza vaccine
- offer pulmonary rehabilitation
- broncodilators
- steroid inhalers to reduce inflammation
- mucolytics to thin mucus
- may offer non-invasive ventilation or oxygen
What is pulmonary rehabilitation?
Used for long term lung conditions with symptoms of breathlessness
2 hours a week for 6-8weeks
Small groups in local centres
Education, exercise, support
Team of professionals including a physio, nurse and OT
Exercise is tailored to help overcome (including the fear of) breathlessness
aims to break the cycle of fear of breathlessness, so less exercise, loose ability to exercise so more breathlessness
What are the NICE guidlines for the diagnosis of COPD?
Symptom analysis - chronic cough and breathlessness (ranked on the MRC dyspnoea scale)
Spirometry - before and after bronchodilators
X-ray - enlarged lungs, pockets or air, change in heart shape (narrowed and elongated due to pressure from the lungs, long term cardiomegaly), bronchovascular markings from phelgm
What services are available to help people stop smoking?
Nicotine replacement therapy
Bupropion (Zyban medication)
Varenicline (Champix)
Motivational interviewing
Group sessions
Smokefree national Helpline
Recommend e-cigareets as a replacement but not on prescription
What are some public health interventions to prevent smoking?
2008 - picture warning on cigarettes
2007 - smoking banned in public places
2015- standardisation of smoking packaging and illegal to smoke in a car with children in
Campaigns : Stoptober
What are the economic impacts of smoking?
Average smoker spends £2,050 a year on cigarettes - £757 million to the economy annually
Costs the NHS £2.6bn annually due to health related conditions
What are the implication of smoking and smoking cessation on preserving lung function particularly FEV1?
Smoking on average reduce life expectancy by 9yrs
Stopping smoking return the rate of lung decline back to normal - earlier you stop smoking the larger the increase in life expectancy
