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Respiratory > COPD > Flashcards

COPD Flashcards

1
Q

What is COPD?

A

Common disease characterised by airflow obstruction which is progressive and not fully reversible. The airflow limitation is associated with abnormal inflammatory response of the lungs to noxious particles or gases

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2
Q

Why is it important to know if patients with COPD are CO2 retainers?

A

Respiratory drive is normally largely initiated by PaCO2 but in COPD, hypoxia can be a strong driving force, which can therefore be reduced if hypoxia is corrected. This means their target sats will be 88-92%.

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3
Q

What ratio would you expect to see in FEV1/FVC in someone with an obstructive lung disorder such as asthma or COPD?

A

<0.7

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4
Q

How do we categorise the severity of COPD based on the FEV1 % predicted?

A

> 80% FEV1 = mild
50-79% FEV1 = moderate
30-49% FEV1 = severe
<30% FEV1 = very severe

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5
Q

COPD is the 4th leading cause of death. Is the prevalence of disease expected to rise or fall?

A

Rise

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6
Q

Most patients with COPD are diagnosed after what age?

A

> 35

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7
Q

COPD is closely linked with levels of? (social)

A

deprivation

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8
Q

What is the biggest risk factor for developing COPD?

A

smoking

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9
Q

Other than smoking, what other risk factors are there for COPD?

A 
air pollution
occupational exposure to dust, fumes and chemicals
age - more common as you age
asthma - overlaps
low socioeconomic status
alpha antitrypsin deficiency
recurrent childhood respiratory infections
genes
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10
Q

2 key pathological changes in COPD?

A

small airways disease

  • airways inflamed
  • airway fibrosis
  • increased airway resistance

Parenchymal destruction
- damage to alveoli and airways which decreases

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11
Q

chronic bronchitis refers to inflammation of the bronchi which is defined as a chronic productive cough for how long?

A

3 months for 2 consecutive years

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12
Q

In COPD, which immune cells are seen infiltrating the airways?

A

neutrophils

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13
Q

When there is chronic bronchitis, what happens in the airways? (3)

A
  1. Goblet cell hyperplasia
  2. Mucus hyper secretion
  3. Chronic inflammation and fibrosis leading to narrower airways
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14
Q

What is emphysema?

A

permanent dilation of the airspaces distal to the terminal bronchioles

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15
Q

What is the effect of enlarged air spaces in the lungs?

A

reduced are for gas exchange and leads to chronic hypoxia

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16
Q

In COPD, inflammatory processes lead to the production of proteases by inflammatory cells. What do these proteases do and what is the effect?

A

protease causes the destruction of elastase which is important in the structural integrity of the alveoli. when this is destroyed, the alveoli can collapse and dilate and bull form.

17
Q

what is cor pulmonale? what is the most common cause of cor pulmonate in the developed world?

A

right ventricular impairment secondary to pulmonary disease. most common cause is COPD.

18
Q

what vascular changes can we see in COPD?

A 
thicker artery walls
poor V/Q mismatch
low PaO2
poor ventilation may give high pCO2
obliteration and vasoconstriction gives pulmonary hypertension
19
Q

clinical features of COPD

A

symptoms

  • chronic cough - usually productive
  • sputum production
  • breathlessness
  • frequent episodes of bronchitis
  • wheeze

signs

  • dyspnoea
  • pursed lip breathing
  • wheeze
  • coarse crackles
  • weight loss
  • hyper expansion of the lungs- downward displacement of the liver
20
Q

signs of cor pulmonale?

A

peripheral oedema
left parasternal heave
raised JVP
hepatomegaly

21
Q

what is the treatment for an acute exacerbation of COPD?

A

bronchodilator given as nebuliser (salbutamol)
oxygen therapy used cautiously
corticosteroids: prednisolone
antibiotics for pneumonia
non-invasive ventilation for hospitalised

22
Q

how do we diagnose COPD?

A

suspected clinically and confirmed using spirometry

23
Q

Describe the MRC dyspnoea scale from 1-5

A
  • 1 = SOB on marked exertion
  • 2 = SOB on hills
  • 3 = Slow or stop on flat ground
  • 4 = Exercise tolerance 100-200 yards on flat
  • 5 = Housebound or SOB on minor
24
Q

A patient comes into clinic complaining of a cough and wheeze. The patient is 14 and finds he is waking up at night wheezing and short of breath. You give him a peak flow diary to record over 2 weeks and it shows marked diurnal variation. What do you think is the problem?

A

Asthma

25
Q

A patient comes in with a chronic cough, producing phlegm and sputum which has been ongoing for a couple of years. She is a smoker of 20 years and doesn’t get any relief when she has used her brothers salbutamol inhaler when she has been breathless. What do you suspect the problem is?

A

COPD

26
Q

What are the key non-pharmacological treatments for COPD?

A

Smoking cessation! - nicotine replacement etc
Remaining active and undertaking regular physical exercise
Exercise training programmes and pulmonary rehabilitation

27
Q

Pharmacological treatment for COPD?

A
  1. SABA to use PRN
  2. LABA + LAMA or LABA + ICS if responds well to steroids
  3. Triple therapy: LABA + LAMA + ICS
28
Q

inhaled corticosteroids can be used in those with COPD. How do they work? What are the risks associated with it?

A

Work by reducing inflammation within the lungs.

Increased risk of pneumonia and withdrawal may lead to exacerbations.

29
Q

For patients with COPD who has severe resting hypoxemia, what treatment can we offer?

A

long term oxygen therapy

30
Q

When is non-invasive ventilation used in COPD?

A

Non‑invasive ventilation is used to treat persistent hypercapnic ventilatory failure and acidosis during an exacerbation of COPD, when a person’s arterial blood gases (especially the pH and carbon dioxide levels) are not responding (or worsening) despite optimal medical management.

31
Q

what surgical treatment can be done in severe cases of COPD?

A

lung volume reduction surgery

32
Q

If a patient presented to the GP with a marked increase in intensity of symptoms of COPD, new physical signs such as tremor, was not responding to initial medical management and had insufficient home support, what would be our next step?

A

Admit to hospital

  • Marked increase in intensity of symptoms
  • Severe underlying COPD
  • Onset of new physical signs
  • Failure of an exacerbation to respond to initial medical management
  • Presence of serious co-morbidities
  • Frequent exacerbations
  • Older age
  • Insufficient home support
33
Q

COPD is often found with other co-morbidities, can you name some?

A 
cardiac disease
cancers
renal failure
diabetes
weight loss
depression
anxiety
osteoporosis

Respiratory (13 decks)

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