COPD * Flashcards
GREEN (43 cards)
What is COPD
Irreversible airway obstruction
characterised with
-chronic bronchitis
-emphysema
-A1AT Deficiency
What is Chronic bronchitis (Blue bloater)
Hypertrophy and hyperplasia of the bronchi mucus glands
Inflammatory cells infiltrate bronchi= lumen narrowing
Results
-mucus hypersecretion
-Cilliary dysfunction
-Narrow lumen
-Increase infection risk with air trapping
Whta is emphysema (Pink puffer)
Airspace enlargement and alveolar wall damage due to elastin destruction
What are the symptoms of COPD
Productive Purulent cough
Dyspnoea and Wheeze
Peripheral oedema (Cor Pulmonale)
Blue Bloater vs Pink puffer
What are the signs of COPD
Accessory muscle respiration Tachypnoea Hyperinflation Cyanosis Cor Pulmonale Quiet breathing Hyper resonant percussion
What are the investigations done for COPD
Spirometry <0.7
*Bronchodilator <12% FEV1 Increase
Bloods (PCV Raised = Polycythemia)
DlCO (Raised in COPD)
ABG (Type 2 resp fail)
ECG (P/Cor Pulmonale)
CXRAY (Barrel chest and Bullae)
What is the spirometry staging for COPD
Mild = FEV1>80 Moderate = FEV1 50-79 Severe = FEV1 30-49 Fatal = FEV1<30
What would an CXR for COPD show
Flat diaphragm and bullae
Flat hemidiaphragm
How do you manage acute COPD after smoking cessation and vaccines
- Bronchodilator and Oxygen (88-92%)
- Oral Prednisolone
- CPAP before intubation/ventilation
Extra = Nebulisers (Salbutamol and Ipratropium)
How do you manage long term COPD with lifestyle change (1st line)
Stop smoking
Change diet
Flu vaccines
Pulmonary Rehab
How do you manage COPD in the long term
- SAB2A/SAMA
- ….+LAB2A and LAMA (Asthmatic symptoms)
- ….+LAB2A and ICS (No Asthmatic symptoms)
- SAB2A +LAB2A +LAMA +ICS
Why might a patient need long term oxygen (LTOT)
<90 O2 Sats on room air PaC02 <7.3kPa with -Polycythemia -Peripheral oedema -Raised JVP -Pulmonary HTN
When should a COPD patient be offered Lung volume reduction surgery
Upper lobe emphysema
FEV1 <20
PaCO2 <7.3
TICO >20
What is the gold standard investigation for COPD
Spirometry w/bronchodilator reversibility
CXR if there are signs of malignancy
What type of ventilation should be used for Tap 1 Respiratory fail
CPAP (Continuous)
When should BiPAP ventilation be used
Type 2 Respiratory fail despite optimum treatment for infection
How does cigarette cause COPD
Mucosal gland hypertrophy
Airways and bronchi walls fill with neutrophils = inflammation
Connective tissue breakdowns and causes emphysema
What are the causes of COPD
Cigarettes
Alpha 1 ATT
Air Pollution
How do cigarettes cause alpha 1 AAT Deficiency
Alpha 1 AAT is responsible for lung protection but cigarettes inactivate this and cause proteolytic lung damage
How does Chronic Bronchitis cause COPD
Mucus gland hypertrophy and hyperplasia = Chronic inflammation infiltrating bronchi/oles = Lumen narrowing
(Blue Bloater)
How does Emphysema cause COPD
Elastin destruction in alveolar air sacs and bronchioles
Air trapped in Bullae distal to blockage (Less elastin to keep walls open in expiration)
(Pink Puffer)
What are Bullae
Large air sacs due to air trapping
What are the four types of emphysema
Centriacinar (Smokers COPD)
Panacinar (A1AT Deficiency)
Distal Acinar
Irregular
Panacinar (A1ATD)
How can A1ATD cause COPD
NORMAL = A1AT destroys neutrophil elastase so elastin layer of lung is intact PATHOLOGICAL = Less Liver production of A1AT = More Neutrophil Elastase = Paracinar emphysema
