COPD Flashcards
1
Q
What is COPD?
A
- a disease characterised by persistent expiration symptoms + airflow obstruction
- due to airways (bronchitis) and/or alveolar (emphysema) abnormalities
- caused by significant exposure to noxious particles or gas
2
Q
What is COPD caused by?
A
Significant exposure to noxious particles or gases e.g. smoking, soot
3
Q
Symptoms of COPD
A
Shortness of breath
Chronic productive cough
Chronic sputum production
Recurrrent lower respiratory tract infections
4
Q
Risk factors for COPD
A
- Smoking
- Host factors e.g. genetics, congenital abnormalities | alpha 1 anti trypsin deficiency
- Occupation
- Indoor/outdoor pollution
- Illicit drug use e.g. heroin
5
Q
What causes airflow limitation in COPD?
A
- Small airways disease: airway inflammation, airway fibrosis > increased airway resistance (+ loss of radial traction)
- Parenchymal destruction: loss of alveolar attachments > decrease of elastic recoil
6
Q
Signs of COPD
A
- purse lip breathing
- prolonged expiratory phase
- hyperinflation or barrel shaped chest
- visible use of accessory muscle
- Tachypnoea
- wheeze on auscultation
- rales (crackles)
- hypoxemia + hypercapnia
7
Q
Signs of late COPD
A
- flapping tremor (hypercapnia)
- central cyanosis (hypoxia)
- right sided heart failure signs e.g. distended neck veins, ankle oedema
8
Q
What is needed to diagnose COPD?
A
Spirometry test
9
Q
Investigations for COPD
A
- spirometry
- BMI
- CXR + CT thorax to exclude other diagnosis
- FBC for polycythemia due to chronic hypoxia, anaemia+ infection
- sputum culture
- ECG + echo to assess heart failure + cor pulmonale
- serum alpha-1 antitrypsin
10
Q
How can you differentiate between asthma and COPD using spirometry?
A
- asthma is reversible so if you give bronchodilators (SABA - salbutamol) the FEV1:FVC will increase (by at least 12%)
- COPD is irreversible so bronchodilators wont increase ratio
11
Q
How much must the FEV1:FVC increase after the use of bronchodilators for the condition to be deemed reversible (asthma)?
A
At least 12%
12
Q
What two main conditions is COPD used to describe?
A
Emphysema: damaged air sacs
Chronic bronchitis: inflammation + productive cough
13
Q
What is emphysema?
A
- condition in which destruction of the terminal bronchioles + distal air spaces occurs via the breakdown of elastin
- permanent enlargement of air spaces (bullae)
14
Q
What is chronic bronchitis?
A
- condition where there is hypersecretion of mucus due to inflammation of large airways
- ciliary dysfunction > issue with clearance
- productive cough
15
Q
What is used to grade dyspnoea?
A
MRC dyspnoea score
16
Q
outline the MRC dyspnoea score
A
- grade 1: breathlessness on strenuous exercise
- grade 2: breathlessness on walking uphill
- grade 3: breathlessness that slows them down walking on the flat
- grade 4: breathlessness stops them from walking >100m on flat
- grade 5: unable to leave the house due to breathlessness
17
Q
How can severity of COPD be graded?
A
using FEV1
- stage 1/mild: FEV1 >80% of predicted
- stage 2/moderate: FEV1 50-79%
- stage 3/severe: FEV1 30-49*
- stage 4/very severe: FEV1 <30%
18
Q
What is exacerbation of COPD?
A
Acute worsening of respiratory symptoms that result in addition therapy
At least one major symptom:
- dyspnoea
- sputum volume
- sputum purulence
And one minor symptom:
- wheezing
- cough
- fever
19
Q
management of COPD exacerbations
A
- oxygen: aim for 94-98% or 88-92% if T2RF or evidence of hypercapnia
- salbutamol + ipratropium nebulisers
- 30mg prednisolone STAT + OD for 7 days
- antibiotics if raised CRP/WCC or purulent sputum
- CXR
- consider NIV if T2FR + low pH
- ITU referral if pH <7.25
20
Q
Outline non invasive ventilation
A
- involves using a full face mask, hood or tight fitting nasal mask to blow air forcefully into the lungs + ventilate them
- involves cycle of high (IPAP ~ 16-20) + low pressures (EPAP ~ 4-6)
21
Q
What does the COPD care bundle consist of?
A
- inhaler technique review
- smoking cessation support
- referral to pulmonary rehabilitation
- review of medications
- follow up OP appointments
- info about support groups, self-management booklets + oxygen alert card
22
Q
Common bacteria that cause COPD
A
- Haemophilus influenzae (most common)
- Streptococcus pneumoniae
- Moraxella catarrhalis
23
Q
Common viruses that cause COPD
A
- rhinoviruses
- coronavirus
- influenza
- parainfluenza
- adenovirus
24
Q
Long term management of COPD
A
- smoking cessation
- pneumococcal + annual flu vaccine
- pulmonary rehabilitation (exercise, nutritional advice + disease education)
- long term oxygen therapy if chronic hypoxia
. - initial medical treatment: SABA + SAMA e.g. salbutamol | ipratropium bromide
- second step if no asthmatic or steroid responsive features: LABA + LAMA combination e.g. anoro ellipta, utibro breezhaler
- second step if asthmatic or steroid responsive features: LABA + ICS combination e.g. seretide, fostair
- final step: LABA, LAMA + ICS combination e.g. trimbow
25
Long term medical management of COPD
- initial medical treatment: **SABA + SAMA** PRN *e.g. salbutamol | ipratropium bromide*
- second step if no asthmatic or steroid responsive features: **LABA + LAMA combination** *e.g. anoro ellipta, utibro breezhaler*
- second step if asthmatic or steroid responsive features: **LABA + ICS combination** *e.g. seretide, fostair*
- final step: **LABA, LAMA + ICS combination** *e.g. trimbow*
26
What therapies improve the symptoms of COPD?
- pulmonary rehabilitation (exercise, nutritional advice + disease education)
- bronchodilators
- lung transplant
- long term oxygen therapy
- lung volume reduction surgery
- mucolytics
27
Outline long term oxygen therapy
When is it offered?
- used to protect organs when hypoxic
- used at least 16 hours/day
- patient must not smoke + not retain high levels of CO2
- offered if pO2 consistently <7.3kPa or <8kPa with cor pulmonale
28
What therapies improves the risk of COPD?
- stop smoking
- oxygen therapy
- anti inflammatories
- non-invasive ventilation
- flu vaccine
- healthy diet
29
When is ambulatory oxygen given?
If patient desaturates when they walk (>4%)
30
What epithelial cells line the airways?
Ciliated pseudostratified columnar
Goblet cells
31
How does exposure to triggers cause COPD?
Hypertrophy + hyperplasia of:
- **bronchial mucinous glands** (main bronchi)
- **goblet cells** (bronchioles)
Production of mucous > obstruction of airways
Smoking also shortens cilia > harder to move mucous
32
FEV1 and FVC in patient with COPD
FEV1 - very low
FVC - low
33
Complications of COPD
- cor pulmonale
- respiratory failure
- pneumothorax
- recurrent pneumonia
34
How can COPD cause cor pulmonae (right sided heart failure)
- vasoconstriction to a large proportion of lungs
- increased pulmonary vascular resistance
- pulmonary hypertension
- more work for right side of heart
- right sided heart failure
35
How can alpha-1 antitrypsin deficiency causes COPD?
- alpha-1 antitrypsin is a antiproteinase
- the deficiency leads to an imbalance in proteinases + antiproteinases
- this leads to destruction of alveolar walls + emphysema
36
Typical colour of purulent sputum
Yellow or green
37
Follow ups for COPD
- review mild, moderate or severe COPD at least once a year
- review very severe COPD (<30% FEV1) at least twice a year
- check inhaler technique
- record smoking status + BMI
- assess for complications
- ensure flu, covid + pneumococcal vaccines have been offered
38
What does ‘ blue bloaters’ and ‘ pink puffers’ mean?
- **blue bloaters**: _chronic bronchitis_ - cyanotic + overweight, peripheral oedema, wheezing
- **pink puffers**: _emphysema_ - older, thin, SOB, use of accessory muscles
39
What medications can be used for palliative management of breathlessness?
- **opiates** *e.g. oral morphine*
- **benzodiazapines** *e.g. lorazepam*
- **oxygen**
