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2. Respiratory Medicine (Lectures) > COPD > Flashcards

COPD Flashcards

(83 cards)

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1
Q

What does COPD stand for?

A

Chronic obstructive pulmonary disease

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2
Q

What is COPD?

A

Chronic, slowly progressive disorder characterised by airflow obstruction that does not change markedly over several months

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3
Q

Which gender gets COPD?

A

Male

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4
Q

Causes of COPD

A

Smoking (85%)
Chronic asthma
Passive smoking
Maternal smoking
Air pollution
Occupation (15-20%)

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5
Q

Examples of occupations causing COPD

A

Coal mining
Hard rock mining
Tunnel working
Concrete manufacturing
Construction
Farming
Foundry working
Plastics
Textiles
Rubber
Leather

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6
Q

What does a1-antitrypsin do?

A

Neutralises enzymes released by neutrophils

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7
Q

Genotypes of a1-antitrypsin deficiency

A

Normal genotype - PiMM (86%)
Troublesome genotype PiZZ (10-20%)

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8
Q

What can happen in a1-antitrypsin deficiency?

A

Bad emphysema can develop very quickly as nothing to neutralise the neutrophils
People tend to develop COPD at younger age

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9
Q

What is the most important cause of COPD?

A

Smoking

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10
Q

What % of smokers develop significant COPD?

A

20%

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11
Q

When would COPD tend to develop in non smokers?

A

Asthma
a1-antitrypsin

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12
Q

What is 1 pack year?

A

1 pack a day for a year

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13
Q

How many pack years does it usually take to develop COPD?

A

20 pack years

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14
Q

What is COPD defined by?

A

Airflow obstruction

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15
Q

Pathology of COPD

A

Luminal obstruction due to small airway narrowing and can be worsened by inflammation and mucus, leading to progressive breathlessness on exertion, along with coughing and wheezing
Breakage of alveolar cell membranes

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16
Q

What is a prime feature of COPD?

A

Mucus secretion

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17
Q

What is chronic bronchitis?

A

Sputum produced every day for at least 2 years

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18
Q

What is ACOS?

A

Asthma/COPD overlap syndrome

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19
Q

What conditions overlap to make up COPD?

A

Chronic bronchitis
Emphysema

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20
Q

Type of airflow obstruction in asthma

A

Reversible

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21
Q

Type of airflow obstruction in COPD

A

Fixed airflow obstruction

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22
Q

Presentation of COPD

A

SOB
- gradual onset
- little variation
- progressively getting worse
Cough
- long history of ‘smokers cough’
- clear of mucoid sputum
Wheeze
- typically on exertion
Progressive difficulty in performing ADLs
Weight loss (severe disease,

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23
Q

Typical COPD patient

A

Patient >40+ years
Smoker / ex smoker
SOB on exertion
Cough

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24
Q

Differential diagnosis of COPD

A

Asthma
Lung cancer
LVF
Fibrosing alveolitis
Bronchiectasis
TB
Recurrent PE

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25
If the patient has symptoms of COPD with haemoptysis, what conditions must be looked into?
Lung cancer TB Bronchiectasis
26
Examples of causes of peripheral oedema
Cor pulmonale Severe disease Respiratory failure
27
Signs of COPD
SOB walking into clinic, undressing Pursed lips Accessory muscles Cyanosis CO2 flap, tremor (B-agonists) Effects of steroids Hyperexpanded (barrel) chest Decreased expansion Less than 3 finger spaces between manubrium and larynx Laryngeal descent Paradoxical movement of ribs and abdomen Decrease in cardiac dullness to percussion Decreased breath sounds Prolonged expiration with wheeze Palpable liver Cor pulmonale
28
Why does pursed lips help in COPD?
Generates a bit more of a positive pressure which causes the airways to open up a bit more
29
Signs of steroid use
Thin skin Bruising Cushingoid
30
Do crackles occur in COPD?
NO
31
Signs of cor pulmonale
Increased JVP Hepatomegaly Ascites Oedema
32
What are acute exacerbations of COPD caused by?
Viral/bacterial infection
33
Causes of acute exacerbation of COPD
Viral/bacterial infection Sedative drugs Pneumothorax Trauma
34
Symptoms of acute exacerbation of COPD
Increased cough Increased sputum Increased SOB increased wheeze Unable to sleep Increased oedema, confusion, drowsiness
35
Investigations for acute exacerbations of COPD
CXR Blood gases FBC U and Es Sputum culture
36
What does spirometry rule out if the FEV1 is normal?
COPD
37
What is a normal FEV1?
> 80% predicted
38
What spirometry result would be abnormal?
FEV1 < 80% predicted with FEV1/FVC ratio < 70%
39
What is emphysema?
Damaged alveoli and so reduced gas transfer
40
In asthma, is the gas transfer affected?
No
41
How is fixed airflow obstruction demonstrated by spirometry?
Minimal bronchodilator reversibility - Baseline, 15 mins post neb 2.5-5mg salbutamol, baseline 30 mins post neb 2.5-5mg salbutamol + 500ug ipratropium Minimal response to oral corticosteriods - 30 - 40mg prednisolone daily for 2 weeks - measure baseline and final FEV1
42
What would a significant bronchodilator/steroid response suggest?
Asthma/asthmatic component
43
What bronchodilator response would be consistent with COPD?
Insignificant bronchodilator / steroid response
44
Investigations for COPD
Spirometry Full pulmonary testing - Lung volumes - carbon monoxide gas transfer CXR ECG Blood gases FBC ECG Sputum sample
45
What may be seen on a CXR in COPD?
Hyperinflated lung fields (>10 posterior ribs) Flattened diaphragms Lucent lung fields Bullae
46
Decreased PaO2 on blood gas indicates what?
Type 1 respiratory failure
47
Decreased Pa02 and increased PaCO2 indicates what?
Type 2 respiratory failure
48
What would be seen on a FBC in COPD?
Secondary polycythaemia (hct > 0.52)
49
What may be seen on an ECG in COPD?
Right axis deviation P pulmonale T wave insertion
50
Inflammation type in COPD
Neutrophilic
51
How to prevent disease progression in COPD?
Smoking cessation
52
How to relieve breathlessness in COPD?
Inhalers
53
How to prevent exacerbations of COPD?
Inhalers Vaccines Pulmonary rehabilitation
54
How to manage complications of COPD
Long term oxygen therapy
55
Non pharmacological management of COPD
Smoking cessation Vaccines (flu, pneumococcal) Pulmonary rehabilitation Nutritional assessment Psychological support
56
Inhaled therapy for COPD
Short acting bronchodilators - SABA (Salbutamol) - SAMA (ipratropium) Long term bronchodilators - LAMA - LABA High dose ICS and LABA - relvar - fostair
57
As there is more symptoms/exacerbations - staging of T for COPD
1. SABA 2. LAMA or LABA 3. Further bronchodilator (LAMA and LABA) 4. Triple therapy (ICS, LAMA, LABA)
58
What does LTOT stand for?
Long term oxygen therapy
59
What Pa02 should LTOT be used at?
< 7.3 kPa 7.3 - 8 kPa if - polycythaemia - nocturnal hypoxia - peripheral oedema - Pulmonary HTN
60
Presentation of COPD exacerbation
Increasing SOB Cough Sputum volume Sputum purulence Wheeze Chest tightness
61
Management of acute exacerbation of COPD
SABA Steroids - prednisolone 40mg per day for 5 - 7 days Antibiotics (if evidence of infection)
62
When should hospital admission be considered if unwell?
Tachypnoea Low oxygen sats (<90-92%) Hypotension etc
63
Ward based management of acute exacerbation of COPD
Oxygen target sats 88 - 92% Nebulised bronchodilators Corticosteriods Antibiotics
64
How can evidence of bronchodilators be assessed/
Clinical ABG
65
What should be done in acute respiratory failure?
Non invasive ventilation (NIV)
66
Management of COPD
Nebulised bronchodilator B2 and antimuscarinic O2 oral / IV corticosteriods Antibiotics Diuretic IV aminophylline Respiratory stimulant NIV
67
An organism causing pneumoniae in a COPD patient is most likely to be what?
Haemophilus influenzae
68
Treatment for COPD (steps)
1st line - SABA or SAMA Next step is determined to do with whether there is asthmatic features/responsiveness No asthmatic features 2. Add LABA or LAMA. Also if already taking a SAMA, switch to a SABA Asthmatic features / responsiveness 2. LABA + ICS 3. Triple therapy i.e. LAMA + LABA + ICS. If already taking a SAMA, switch to a SABA
69
What NICE criteria would suggest that a patient has asthmatic features/responsiveness in COPD?
Any previous secure diagnosis of asthma or atopy A higher eosinophil blood count Substantial variation in FEV1 over time (at least 400ml) Substantial diurnal variation in PEFR (at least 20%)
70
What prophylaxis may be done in select patients with COPD?
Azithromycin
71
Monitoring of azithromycin
LFTs ECG to exclude QT prolongation
72
Who with COPD should be considered to get mucolytics?
Chronic productive cough and continued if symptoms improve
73
Treatment of cor pulmonale
Loop diuretic Oxygen long term
74
What vaccinations should a COPD patient get?
Annual flu One off pneumococcal
75
What pH does NIV show most benefit?
7.25 - 7.35
76
What pH should invasive ventilation be carried out?
< 7.25
77
What can large bullae in COPD mimic?
A pneumothorax
78
What is the severity of COPD judged by?
FEV1
79
1st line antibiotics for an infective exacerbation of COPD
Amoxicillin or clarithromycin or doxycycline
80
In alpha-1-antitrypsin deficiency, where is empysema more prominent in the lungs and how does this compare to in COPD?
Lower lobes in A1ATD Upper lobes in COPD
81
1st line pharmacological management of COPD
SABA or SAMA
82
What criteria should be used to determine if patients having an exacerbation of COPD should require antibiotics?
Those with purulent sputum or clinical signs of pneumonia
83
From the NICE guidelines, it is recommended that patients who have had frequent exacerbations of their COPD should be given what?
A home supply of prednisolone and antibiotics

2. Respiratory Medicine (Lectures) (50 decks)

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