3.3 Chronic Obstructive Pulmonary Disease Flashcards
What presentations and risk factors could point to COPD over asthma? (history)
Smoker or ex-smoker
Over 35
Chronic productive cough
Persistent and progressive breathlessness
Risk factors for COPD
Tobacco exposure
Cannabis use (especially young age)
Indoor air pollution
Alpah-1 antitrypsin deficiency (especially young age)
What is the gold standard investigation for CPOD
Spirometry
What is the pathohistology of COPD lung tissue?
Inflammation - large number of lymphocytes
Goblet cell hyperplasia
Airway narrowing (scarring and mucous)
Alveolar destruction
What element of COPD did we used to call chronic bronchitis?
Cough and sputum production due to goblet cell hyperplasia
What are the cardinal symptoms of COPD?
Cough
Sputum
Breathlessness
Wheeze
What doees the post-bronchodilator FEV1/FEV ratio have to be to confirm a diagnosis of COPD?
<0.7
What is the gold standard classification of COPD severity?
FEV1 % predicted
> /= 80% Stage 1 – Mild
50–79% Stage 2 – Moderate
30–49% Stage 3 – Severe
<30% Stage 4 – Very severe (or FEV1 below 50% with respiratory failure)
What is the natural history of progression of COPD?
- Progressive decline in lung function
- Progressive dyspnoea and disability
- Right ventricular failure (‘cor pulmonale’)
- Exacerbations become more frequent and contribute to morbidity and disability
What is cor pulmonale?
Right ventricular failure due to back pressure from the lungs
What causes cor pulmonale in COPD?
- Hypoxia
- Pulmonary artery vasoconstriction
- Increased pulmonary artery pressure
- Right ventricular hypertrophy
- Right ventricular failure
How do we manage COPD in terms of optimising the patient?
Smoking cessation
Vaccinations
Physiotherapy/pulmonary rehab
Treat comorbidities
Self management plan
What can we prescribe for smoking cessation? (5)
Behavioural support
Nicotine replacement therapy (short and long acting e.g. patch, gum, inhalator)
Bupropin (noradrenaline dopamine reuptake inhibitor)
Varenicline/Champix (nicotine receptor parital agonist)
Nicotine e-cigarette (not licensed)
When should we prescribe inhaled therapies for COPD?
To relieve SOB and exercise limitation
Only if the patient has satisfactory technique
What are the four main types of inhaler?
Breath activated
Dry powder
Metered dose
Spacer
