COPD Flashcards
1
Q
What is the definition of COPD?
A
Chronic obstructive pulmonary disease
Poorly reversible airflow limitation that is usually progressive
FEV1/FVC <0.7
FEV < 80%
2
Q
What is the pathology of COPD?
A
- Associated with persistent inflammatory response of the lungs
- Chronic bronchitis
- Airway narrowing = airflow limitation
- Hypertrophy and hyperplasia of mucus secreting glands
- Bronchial wall inflammation
- Mucosal oedema
- Epithelial cell layer may ulcerate
- Squamous epithelium may replace columnar epithelium when ulcers heal = squamous metaplasia
- ‘Blue bloaters’ = bronchitis>emphysema
- Emphysema
- Dilatation and destruction of the lung tissue distil to the terminal bronchioles
- Loss of elastic coil
- Expiratory air flow limitation and air trapping
- ‘Pink puffer’ = emphysema>bronchitis
- Smoking
- Causes mucous gland hypertrophy in larger airways
- ↑ in neutrophils, macrophages and lymphocytes in the walls
- α1 – antitypsin deficiency is inactivated by cigarette smoke
3
Q
What are the risk factors/aetiology of COPD?
A
- Smoking
- Exposure to pollutants e.g. mining, building, chemical industries
- Outdoor air pollutions
- Inhalation of smoke e.g. biomass fuels
- Alpha-1 antitrypsin deficiency – early onset
4
Q
What are the signs/symptoms of COPD?
A
• Productive cough – inc. purulent sputum • Wheeze • Breathlessness at rest • Prolonged expiration • Poor chest expansion • Lung hyperinflation – loss of cardiac and liver dullness • Cyanosis • Oedema • CO2 retention • warm peripheries • bounding pulse • flapping tremor • confusion Thin with loss of muscle mass Pursed lip breathing Increased work of breathing: Leaning forward Accessory muscles of respiration Tracheal tug Nasal flare Paradoxical abdominal movement Indrawing of intercostal muscles
5
Q
What investigation are conduced for suspected COPD?
A
- Lung function tests
- Peak flow
- Spirometry
- CXR
- CT
- FBC – haem and packed cell volume may be high due to persistent hypoaemia
- ABG
- α1 – antitypsin serum levels
- EGC – for cor pulmonale
6
Q
What are the surgical treatments for COPD?
A
- Bullectomy – for patients with large emphysematous bullae
* Lung volume reduction surgery - severe
7
Q
What are the pharmacological treatments for COPD?
A
- Bronchodialators – e.g. tiotropium bromide
- Corticosteroids e.g. prednisolone
- Abx – rescue pack for acute exacerbations
- Pneumococcal vaccine
- Mucolytics
- Diuretics – for oedema
8
Q
What are the non pharmacological treatments for COPD?
A
- Smoking cessation
- Oxygen
- Exercise training
- High calorie diet
