Chronic Obstructive Pulmonary Disease Flashcards
(106 cards)
1
Q
What medication did he recently take for his chest infection?
A
Amoxicillin
2
Q
What is his smoking history?
A
30 pack-year
3
Q
What symptoms and signs does Mr Craven present with?
A
‘Catching his breath a bit over the last few months’
Finds climbing the stairs and running for more difficult
Slower pace when walking
4
Q
What does the GP suggest?
A
Breathing test using spirometer
Set up meeting with stop smoking counsellor
5
Q
What does the GP say is the best way to stop smoking?
A
Combination of medication and specialist support
6
Q
What are the 4 main causes of breathlessness?
A
Lung conditions
Heart conditions
Anxiety
Being unfit
7
Q
How can lung conditions cause breathlessness?
A
Cause airways to become inflamed and narrowed
Fill the airways with phlegm so it harder for air to move in and out of the lungs
Make the lungs stiff and less elastic so its harder for them to expand and fill with air
8
Q
Give examples of lung conditions that can causes long-term breathlessness?
A
COPD Asthma Interstitial Lung disease (inc. pulmonary fibrosis) Bronchiectasis Industrial/Occupational e.g. asbestosis Lung cancer
9
Q
What lung conditions cause acute breathlessness?
A
Asthma/COPD flare up Pulmonary embolism Pneumonia Tuberculosis Pneumothorax Collapsed lung Build up of fluid in lung or lining of lungs
10
Q
How can chronic breathlessness be caused by heart conditions?
A
Problems with: Rhythm Valves Cardiac muscles Heart is unable to increase its pumping strength in response to exercise
11
Q
When might heart failure due to breathlessness worsen?
A
Worse at night or when asleep
12
Q
Which heart conditions can cause acute breathlessness?
A
Heart attack
Abnormal heart rhythm
(palpitations)
13
Q
How can anxiety cause breathlessness?
A
Normal body response by your body to what you think is a stressful situation
Your body prepares for action
As you get more anxious you may start to breather faster and tense your breathing muscles
14
Q
What is a panic attack?
A
When your body’s normal response is exaggerated
Rapid build up of physical responses
Body tries to take in more oxygen so heart beats faster and muscles tense
15
Q
What are the symptoms of a panic attack?
A
Have a pounding heart Feel faint Sweat Feel sick Have shaky limbs Feel you're not connected to your body
16
Q
Why might being unfit cause breathlessness?
A
Muscles get weaker
Weaker muscles need more oxygen to work
17
Q
How can being an unhealthy weight make us feel breathless?
A
Underweight: Breathing muscles will be weaker
Overweight: More effort to breathe and move around
Having more weight in chest or abdomen restricts how much you lungs can move
18
Q
What BMI value will mean you are more susceptible to breathlessness?
A
25
19
Q
What can people who are severely overweight develop?
A
Obesity hypoventilation syndrome
20
Q
Want is obesity hypoventilation syndrome?
A
Poor breathing leads to lower oxygen levels and high CO2 levels in their blood
21
Q
What are the other reasons of chronic breathlessness?
A
Smoking
Conditions that affect how your muscles work
e.g. muscular dystrophy, MG and motor neurone disease
Postural conditions that alter the shape of your spine e.g. scoliosis and kyphosis
Anaemia
Kidney disease
Thyroid disease
22
Q
What should someone experiencing breathlessness do when they go to see their doctor?
A
Think about how they’ll describe their breathlessness
Bring someone who can help
23
Q
What is the MRC breathlessness scale?
A
Scale health professionals use to measure breathlessness
Shows what it stops you from doing
24
Q
What does grade 1 on the MRC scale represent?
A
Not troubled by breathlessness except on strenuous exercise
25
What does grade 2 on the MRC scale represent?
Short pf breath when hurrying on the level or walking up a slight hill
26
What does grade 3 on the MRC scale represent?
Walks slower than most people on the level, stops after a mile or so, or stops after 15 minutes walking at own pace
27
What does grade 5 on the MRC scale represent?
Too breathless to leave the house, or breathless when undressing
28
What is important to tell your doctor?
what you used to be able to do that you can’t do any more
what people of your age around you do that you think you should be able to do
what your personal goals are for your day-to-day activity
29
What tests might a GP carry out?
```
No. of breaths per minute
Listen to your chest
Feel how your chest moves as you breathe
Heart rate and rhythm
Blood pressure and temperature
Height, Weight, Waist and BMI
Examine head/neck and armpits for swollen lymph glands
Look at eyes, nails, skin and joints
Blood oxygen levels
```
30
What may a GP refer a patient with breathlessness for?
```
Chest X-Ray
Spirometry
ECG
Echocardiogram
Blood tests
```
31
What could blood tests detect?
Anaemia
Allergies
Thyroid/ Liver/ Kidney/ Heart problems
32
What would you look for on chest radiography?
Signs of heart failure
| Pulmonary pathology
33
What would you look for on a ECG?
Heart failure
Arrhythmia
Pulmonary embolism
34
What would you look for when performing a spirometry test?
Signs of obstructive airway disease
| Restrictive pattern associated with interstitial lung disease
35
What would a U+E and a blood glucose test show?
Renal failure and diabetes as causes of metabolic acidosis and breathlessness
36
What could a thyroid function test detect?
Thyroid disease as a cause of breathlessness
37
How can you assess heart failure?
B-type natriuretic peptide test
38
What factors are characteristic of asthma?
A large response to bronchodilators
| Significant diurnal or day-day variability of serial peak flow measurements
39
What should you do for patients with COPD?
arrange chest radiography to exclude other serious lung pathology (such as lung cancer) and check the full blood count to identify anaemia or polycythaemia
40
What is SOBOE?
Shortness of breath on exertion
41
What are the possible respiratory differential diagnosis for Mr Craven?
```
Asthma
COPD
Pulmonary fibrosis
Lung cancer
Pulmonary embolism
Pneumothorax
Lower respiratory tract infection
```
42
What are the possible cardiovascular/systemic differential diagnosis for Mr Craven?
```
Congestive heart failure
Pulmonary oedema
Valvular defects
Acute coronary syndrome
Anaemia
Renal or liver failure
Deconditioning
```
43
What questions would you ask to hone this differential?
```
Chest pain?
Does it wake you up at night?
Does it get worse whilst lying flat?
Any lifestyle changes?
Occupation?
Cough?
```
44
What examinations would you perform to hone this differential?
```
Check for lung/breath sounds
(Lamina or Turbulent flow/ Crackling)
Cyanosis
Barrel chest: hyper-expanded
Pitting Oedema
Tar staining on fingernails
Heart sounds: leaky valves/murmurs
```
45
What happens if the LHS of the heart isn't functioning?
Pooling of blood/fluid in the lungs
46
What happens if the RHS of the heart isn't functioning?
Oedema in the legs
47
What investigations would you carry out?
ECG
CXR
Spirometry
Blood tests
48
What is FVC?
Forced vital capacity
| Total volume of air expelled after inhalation
49
What is FEV1?
Forced expiratory volume
| Volume expelled after inhalation on 1 second
50
Give examples of restrictive diseases
```
Obesity
TB
Scoliosis
Neuromuscular weakness e.g. MG
Pulmonary fibrosis
```
51
Give examples of obstructive diseases
```
COPD
Asthma
Cystic fibrosis
Emphysema
Chronic Bronchitis
```
52
What characterises a obstructive disease?
FEV1/FVC ratio of less that 0.7
Only expel less than 70% of your total volume in 1 second
Narrowing of airways
53
What characterises a restrictive disease?
FEV1/FVC ratio higher or normal
FVC is lower by FEV1 the same
Something preventing your lungs from expanding fully
54
What does COPD encompass?
Bronchitis
| Emphysema
55
What is the pathophysiology for Bronchitis?
```
Inflammation and irritation
Caused by smoking, asbestos etc.
Hypertrophy of goblet cells
Increased mucus production
Airway narrowing- increase blood flow, inflammatory mediators therefore wall thickens, lumen narrows
Inhibits action of cilia
```
56
What is the pathophysiology of emphysema?
```
Damage to the walls of the alveoli
via elastase enzyme
Reduces surface area for gas exchange
Alveoli unable to recoil
Air becomes trapped
```
57
How does emphysema cause an obstructive disorder?
Less pressure and force keeping the airways open and they collapse in on themselves
Damage of the alveoli (surrounding tissue) causes this
58
What abnormalities are seen on Mr. Craven's X-ray?
Diaphragm is flattened
Smaller/Elongated heart
Barrel chest
59
What are the signs of hyperinflation?
More the 7 anterior ribs visible at the mid-clavicular line
Flattening of the diaphragm
Heart may appear small and narrow
Bullae
60
What causes hyperinflation?
Emphysema
61
What are bullae?
When alveoli become a singular unit
Very big
Delicate outer wall
Can burst causing pneumothorax
Air filled spaces with thin walls, bordered only by remnants of alveolar septae
Shown as black areas on CXR
62
What are steps that someone can take to stop smoking?
Nicotine replacement therapy e.g. patches, sprays, lozenges etc.
Smoking cessation therapist
Education about the harmful affects of smoking
63
Why is nutrition important in COPD?
Boost immune system to prevent infection
Deal with practical issues e.g unable to eat while coughing
If malnourished, muscles are weaker affecting breathing
If obese, difficulty in expanding the chest
64
How can improvements in nutrition be made?
Referral to dietician
| Patient resources
65
Why is important to keep well in the cold?
Increased risk of infection during the winter
Flu jab
Pneumoccocal vaccine
Infective exacerbate of COPD- rescue packs with steroids and antibiotics
66
What are the three main categories of inhaled medications?
Inhaled corticosteroids
Anti-cholinergics
Beta agonists
67
What is the mechanism of beta agonists?
Bronchodilation
| Sympathetic nervous system stimulation
68
What is the mechanism of anticholinergics?
Prevent bronchoconstirciton
| Act against parasympathetic nervous system
69
What is the mechanism of corticosteroids?
Reduce inflammation
70
What is the main cause of preventable illness and premature death in the UK?
Smoking tobacco
71
What can smoking cessation be associated with?
Temporary withdrawal symptoms
| Caused by nicotine dependence
72
What are symptoms of withdrawal?
```
Nicotine cravings
Irritability
Depression
Restlessness
Poor concentration
Light-headedness
Sleep disturbances
Increased appetite
```
73
What is recommended to be the most effective approach?
Abrupt quiting
| Combination of drug treatment and behavioural support
74
Where should patients wishing to stop smoking be referred to?
local NHS stop smoking serviced
| if the decline to attend a suitable healthcare professional
75
What is NRT?
Nicotine replacement therapy
76
What drugs are used in NRT?
Varenicline (Champix)
| Bupropion hydrochloride
77
What is taken in to consideration when choosing which drug?
```
Smoker's adherence
Preference
Previous experience of smoking-cessation aids
Contra-indications
Side effects
Pregnancy/ Breastfeeding
```
78
What are he most effective options?
Varenicline OR
combination of long-acting NRT (transdermal patch) and short-acting NRT (lozenges, gum, sublingual tablets, inhalator, nasal spray and oral spray)
79
What can be used if the most effective treatments options are not appropriate?
Bupropion hydrochloride
| Single therapy NRT
80
How are patches applied?
Transdermal
16 hours
Removed overnight
If they experience cravings on waking a 24 hour patch can be used
81
When are short acting nicotine preparations used?
Whenever the urge to smoke occurs or to prevent cravings
82
How may smokers who are unwillingly to stop use NRT?
'Harm reduction approach'
Smoking reduction
Temporary abstinence
Improves chance of stopping smoking in the long term
83
How do e-cigarettes work?
Deliver nicotine without the toxins found in tobacco smoke
| Cannot be prescribed
84
How does smoking affect pregnancy?
Harmful effects of exposure to second-hand smoke for both mother and baby
Ongoing support should be offered during and following pregnancy.
NRT should only be used in pregnant females if non-drug treatment options have failed
85
What may cause an increase in dose in other drugs?
Polycyclic aromatic hydrocarbons found in tobacco smoke increase the metabolism of some drugs
86
What forms of NRT therapy are available?
```
Skin patches
Chewing gum
Inhalators
Tablets, oral strips and lozenges
Nasal and mouth spray
```
87
How long does NRT treatment last?
Typically 8-12 weeks
Gradually reduce the dose
Eventually stop
88
Who can use NRTs?
Over 12s
Under 18s shouldn't use lozenges without medical advice
Pregnant women
Breastfeeding women
89
What are the possible side effects of NRTs?
```
Skin irritation
Irritation of nose, throat or eyes
Difficulty sleeping
Upset stomach
Dizziness
Headaches
```
90
How is Varenicline taken?
1-2 tablets a day
| A week or two before starting to quit
91
Who cannot take Varenicline?
Children under 18
Pregnant/Breastfeeding women
People with severe kidney problems
92
What are the side effects of Varenicline?
```
feeling and being sick
difficulty sleeping (insomnia), sometimes with vivid dreams
dry mouth
constipation or diarrhoea
headaches
drowsiness
dizziness
```
93
How is bupropion taken?
1-2 tablets a day
1-2 weeks before quitting
7-9 weeks with treatment
Cannot be taken by people with epilepsy/bipolar disorder/ eating disorders
94
What are the side effects of bupropion?
```
dry mouth
difficulty sleeping (insomnia)
headaches
feeling and being sick
constipation
difficulty concentrating
dizziness
```
95
What are the fundamentals of COPD care?
```
Offer treatment and support
Offer pneumococcal and flu vaccines
Offer pulmonary rehab
Co-develop a self-management plan
Optimise treatment for co-morbidities
```
96
When are inhaled therapies needed?
Relieve breathlessness
Exercise limitation
Other therapies were not successful
97
What is a pMDI?
Pressurised metered dose inhaler
98
What is a spacer?
Can be used to reduce side effects and alleviate symptoms
| Lesser dose
99
How long should you wait between puffs?
30 seconds - 1 minute
100
How should you use a Respimat (SMI) inhaler?
```
Prime the inhaler
Twist until clicks and open cap
Hold horizontally
Sit or stand up straight
Tilt chin up
Breathe out gently and slowly
Make tight seal with lips
Breathe in steadily and press grey button
Hold press for at least 10 seconds
```
101
How many times do you need to prime your inhaler?
If not used in 1 week: Once
| If not used in 3 weeks: 3 times
102
What should you do if you have used an inhaler that contains steroids?
Rinse your mouth with water
103
What is a turbohaler inhaler?
Dry powder device
| DPI
104
How do you prime a turbohaler?
Twist off cover and hold upright
| Turn base one way and then the other until a click is heard
105
How do you use a turbohaler?
```
Hold upright
Sit or stand up straight
Tilt chin up
Breathe out gently and slowly
Make tight seal with lips
Breathe in steadily and press grey button
Hold press for at least 10 seconds
```
106
How do you use a turbohaler?
```
Hold upright
Sit or stand up straight
Tilt chin up
Breathe out gently and slowly
Make tight seal with lips
Breathe in quickly and press grey button
Hold press for at least 10 seconds
```
