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MD2 Intersession 2 > Chronic Obstructive Pulmonary Disease (COPD) > Flashcards

Chronic Obstructive Pulmonary Disease (COPD) Flashcards

(52 cards)

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1
Q

What is COPD?

A

Group of disorders characterised by airway inflammation and airflow limitation > not fully reversible
Progressive
Abnormal inflammatory response to noxious stimuli

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2
Q

What is the pathogenesis of COPD?

A 
Noxious agent > inflammation >
- Small airway disease >
   - Airway inflammation
   - Airway remodelling
- Parenchymal destruction >
   - Loss of alveolar attachments
   - Loss of elastic recoil
Airflow limitation
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3
Q

What are the mediators of inflammation in the airways, lung parenchyma, and pulmonary vessels?

A 
Neutrophils
Macrophages
CD8 T cells
Proteinase-antiproteinase imbalance
Oxidative stress
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4
Q

What are the changes in lung parenchyma in COPD?

A

Alveolar wall destruction
Loss of elasticity
Destruction of pulmonary capillary bed
Increased inflammatory cells

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5
Q

What is the mechanism of emphysema?

A

Proteinase-antiproteinase imbalance > digestion of elastin and other structural proteins in alveolar wall

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6
Q

What inflammatory cells are prominent in emphysema?

A

Macrophages

T cells

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7
Q

What are the different patterns of emphysema?

A

Centriacinar = radiates from terminal bronchiole
Panacinar = more generalised
Bullae

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8
Q

What are the risk factors for COPD?

A 
Primary = cigarette smoking
Occupational exposure to irritants
Alpha1- antitrypsin deficiency
Bronchial hyper-responsiveness
Passive smoking
Air pollution
- Indoor
- Outdoor
Recurrent respiratory tract infections in childhood
Genetic predisposition
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9
Q

In whom should you consider COPD in?

A 
Any past/current smoker
Chronic cough
Productive cough
Dyspnoea
History of exposure to other risk factors
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10
Q

How is COPD diagnosed?

A 
Spirometry best measure of airflow obstruction
FER = forced expiratory ratio
FER = FEV1/FVC pr FEV1/VC
- Using larger of FVC or VC
FER <0.7 > airflow obstruction
- Cut-off varies with age
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11
Q

Compare the course of COPD and asthma

A 
COPD = progressive
Asthma = variable
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12
Q

Compare the time of onset of symptoms in COPD and asthma

A 
COPD = late onset of symptoms
Asthma = generally young age of onset
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13
Q

Compare the association of smoking with COPD and asthma

A 
COPD = usually moderately heavy smoking history
Asthma = no association with smoking history
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14
Q

Compare airflow limitation in COPD and asthma

A 
COPD = not completely reversible
Asthma = Substantially/completely reversible
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15
Q

Compare the inflammatory mediators in COPD and asthma

A 
COPD = neutrophils
Asthma = largely eosinophils
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16
Q

Compare the airways involved in COPD and asthma

A 
COPD = mostly peripheral airways
- Fibrosis > obliterative bronchiolitis
Asthma = all airways
- Doesn't involve lung parenchyma
- No fibrosis
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17
Q

Compare mucus hyper-secretion in COPD and asthma

A 
COPD = more prominent
Asthma = less prominent
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18
Q

What are the goals of therapy in COPD?

A

Control symptoms
Improve lung function and health status
Prevent exacerbations
Reduce hospital admissions

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19
Q

What is the management of COPD?

A

COPD-X plan

  • C = confirm diagnosis and assess severity
  • O = optimise lung function
  • P = prevent deterioration
  • D = develop support network and self-management plan
  • X = exacerbation - manage appropriately
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20
Q

Does ceasing smoking in COPD have any effect?

A

Yes, slows decline in lung function

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21
Q

What is Ventolin and Airomir?

Study These Flashcards
A

Salbutamol = SABA

22
Q

What is Bricanyl?

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A

Terbutaline = SABA

23
Q

What is Serevent?

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A

Salmeterol = LABA

24
Q

What is Oxis and Foradile?

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A

Eformoterol = LABA

25
What is Onbreez?
Indacaterol = LABA
26
What is the use of short-acting beta-agonists in COPD?
PRN
27
What is the use of long-acting beta-agonists in COPD?
Regular use > - Fewer symptoms - More exercise - Better QOL
28
What are the side effects of beta agonists?
Tremor | Tachycardia
29
What is Spiriva?
Tiotropium = LAMA
30
What is Atrovent?
Ipratropium = LAMA
31
What is Seretide?
Fluticasone = steroid + salmeterol = LABA
32
What is Symbicort?
Budesonide = steroid + formoterol = LABA
33
What does combination therapy (inhaled steroid + LABA) do in moderate to severe COPD?
Reduce exacerbations Improve QOL Improve FEV1
34
What does pulmonary rehabilitation do?
Improves exercise capacity and QOL | May reduce exacerbations and hospitalisations
35
What are the two main components of pulmonary rehabilitation?
Improve fitness | Education
36
What are the vaccines given in COPD as part of management?
Influenza vaccine - Yearly Pneumococcal vaccine - Twice 5 years apart
37
What is the role of home oxygen therapy in COPD?
Improves mortality | No effect on symptoms
38
How is home oxygen therapy administered?
2-4 L/min via nasal prongs for >16 hours/day if - PO2 on air at rest <55 mmHg OR - PO2 <60 mmHg with evidence of hypoxic damage - No cigarette smoking for 3 months
39
What are some examples of hypoxic damage in COPD?
Cor pulmonale Pulmonary HTN Polycythaemia
40
What are some other treatments in COPD?
``` Chronic ABs - Generally not recommended Mucolytics - Small benefit - May help some patients Non-invasive ventilation - Unproven for chronic use - Only used in some patients Lung volume reduction surgery - Improves symptoms - Improves QOL - No clear survival advantage - Consider lung transplant ```
41
What is recommended therapy at stage I (mild) COPD?
Active reduction of risk factors Vaccinations Add short-acting bronchodilators
42
What is recommended therapy at stage II (moderate) COPD?
Add regular treatment with 1+ long-acting bronchodilators PRN Add rehabilitation
43
What is recommended therapy at stage III (severe) COPD?
Add inhaled glucocorticosteroids if repeated exacerbations
44
What is recommended therapy at stage IV (very severe) COPD?
Add long-term oxygen if chronic respiratory failure | Consider surgical treatments
45
What is an exacerbation of COPD?
Change in patient's baseline dyspnoea and/or sputum Beyond day-to-day variations Acute onset
46
What are some causes of acute exacerbations of COPD?
``` Respiratory infections Heart failure Arrhythmia Systemic infection Anaemia Anxiety Anything increasing metabolic rate ```
47
What are the complications of exacerbations of COPD?
Decline in QOL More rapid loss of lung function Mortality
48
What is the Anthonisen criteria for COPD exacerbations?
Increased dyspnoea Increased sputum production Sputum becoming discoloured
49
What is the management for exacerbations of COPD?
ABs to cover Strep and Gram negatives useful if all 3 Anthonisen criteria present CXR looking for pneumonia Cover atypical bacteria if pneumonia present Supplemental O2 - Aim to keep SpO2 >90% and/or PaO2 >60 mmHg
50
How can a high dose of O2 in COPD with chronic hypercapnia cause a further rise in pCO2?
Reduced ventilatory drive High PO2 in parts of lung overcoming hypoxic vasoconstriction > worsening V/Q mismatch Haldane effect + O2 displacing CO2 from Hb
51
What are other therapies in exacerbations of COPD?
``` Bronchodilators Oral corticosteroids ABs if evidence of infection Physical activity to prevent deconditioning Non-invasive ventilation ```
52
How do you prevent exacerbations of COPD?
``` Smoking cessation Vaccinations Tiotropium LABAs Theophylline Inhaled corticosteroids Inhaled corticosteroids + LABA Pulmonary rehab Mucolytics ```

MD2 Intersession 2 (1 decks)

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