COPD Flashcards
1
Q
What does COPD stand for?
A
Chronic Obstructive Pulmonary Disease
2
Q
What is the problem with COPD?
A
- Severe COPD leads to respiratory failure, hospitalization and eventually death from suffocation
3
Q
Describe the lungs of a person with COPD
A
- Lungs with COPD have these common characteristics:
- Bronchioles lose their shape and become clogged with mucus
- Walls of Alveoli are destroyed, forming fewer larger alveoli
4
Q
What are the 2 types of patients with COPD?
A
- Blue bloaters
- Pink puffers
5
Q
Describe the characteristics of blue bloaters
A
- Chronic Bronchitis
- Clinical diagnosis: Daily productive cough for 3 months or more, in at least 2 consecutive years
- Overweight and cyanotic, Elevated hemoglobin, Peripheral Edema, Rhonchi and Wheezing
- PaCO2 > 45 mmHg, PaO2 < 60 mmHg
6
Q
Describe the characteristics of Pink Puffers
A
- Pathological diagnosis: Permanent enlargement and destruction of airspace’s distal to the terminal bronchioles
- Older and thin
- Severe dyspnea
- Quiet chest
- X-ray: Hyperinflation with flattened diaphragms
- normal PaCO2, PaO2 > 60 mmHg
7
Q
What is COPD?
A
- Condition caused by interaction between host genetic susceptibility and environmental exposures
- a1-antitrypsin and exposure to smoking/dust
- GWAS show that multiple genetic loci are involved
- Heterogeneous diseases with multiple causal pathways resulting in irreversible airways disease
- COPD consists of 2 conditions affecting small airways and alveoli
8
Q
Describe the epidemiology of COPD
A
- Highly prevalent in regions such as northern England, Russia, South Africa
- Most other areas have a medium level of prevalence
9
Q
Where was the burden increasing the fastest between 1990 and 2020?
A
- Formerly socialist economies of Europe: 120%
- China: 175%
- Sub-Saharan Africa: 200%
- Other Asia and Islands: 250%
- Latin America and Caribbean: 300%
- Middle Eastern Crescent: 700%
10
Q
What did the global burden of disease study report in 2016?
A
- Reported a prevalence of 251 million cases of COPD globally in 2016
- Globally, it is estimated that 3.17 million deaths were caused by the disease in 2015
- That is, 5% of all deaths globally in that year
11
Q
List the risk factors of COPD
A
- Nutrition
- Infections
- Socio-economic status
- Aging Populations
- Smoking, Occupational dust and chemicals, Environmental tobacco smoke, Indoor and outdoor air pollution
12
Q
List a key fact about smoking in high income countries
A
- At least 90% of COPD in high income countries is linked with smoking (US)
- In men, smokers are 26 times more likely to die from COPD than their non-smoking counterparts
- In women, Smokers are 22 times more likely from COPD than non-smoking women
13
Q
What are the origins of COPD?
A
Classic view is that all adults reach maximal lung volume at 25 years and decline in lung function after this determines COPD risk depending on environmental exposures
14
Q
What are the effects of smoking and smoking cessation?
A
- % of FEV1 value at age 25 years declines
- VD
15
Q
What is the modern view of origins of COPD?
A
- Heterogeneous disease
- Multiple phenotypes, endotypes and associated causal mechanisms
- Longitudinal studies indicate 3 main trajectories of lung function from early childhood to development of COPD
- Normal to adulthood then rapid decline (e.g smoking)
- Born with reduced lung function and rapid decline (eg prematurity + childhood asthma)
- Born with reduced lung function and normal
16
Q
What are the lung function trajectories in COPD?
A
- Percentage of predicted FEV1:
- Stays at 100 with normal lung function
- Declines from 96% to 75%
- Decline in lung function associated with smoking from 100% to 76%
- Early origins of airflow limitations stays at 70%
17
Q
List the potential causes of reduced lung function before 25 years
A
- Host genetics (eg alpha-1 antitrypsin)
- Prematurity
- Maternal smoking
- Early childhood respiratory infections
- Childhood asthma
- Adolescent smoking
- Indoor and outdoors air pollution
18
Q
How is COPD diagnosed?
A
- Symptoms: Cough, Sputum, Shortness of breath
- Exposure to risk factors: Tobacco, Occupation, Indoor/Outdoor pollution
- Both add up to spirometry
19
Q
List the spirometry results for COPD diagnosis
A
- Normal: FEV1 = 4.150, FVC = 5.200, FEV1/FVC = 80%
- COPD: FEV1 = 2.350, FVC = 3.900, FEV1/FVC = 60%
20
Q
List the spirometry results for COPD clarification
A
- Stage 1: Mild - FEV,/FVC < 0.70 FEV, ≥ 80% predicted
- Stage 2: Moderate - FEV /FVC < 0.70 50% ≤ FEV, < 80% predicted
- Stage 3: Severe - FEV1/FVC < 0.70 30% ≤ FEV, < 50% predicted
- Stage 4: Very Severe - FEV,/FVC < 0.70, FEV1 < 30% predicted or FEV, < 50% predicted plus chronic respiratory failure
21
Q
List the four components of care
A
- Assess and Monitor Disease
- Reduce Risk Factors
- Manage Stable COPD
- Manage Exacerbations
22
Q
List the different therapies at each stage of COPD
A
- At stage 1,2,3: Add a short acting bronchodilator
- At stage 2,3,4: Add regular treatment or more long acting bronchodilators (when needed), Add rehabilitation
- At stages 3,4: Inhaled glucocorticosteroids if repeated exacerbations
- At stage 4: Add long term oxygen if chronic respiratory failure. Consider surgical treatments
23
Q
What are the issues of COPD in LMIC’s? (PART 1)
A
- Social and economic burden of COPD is increasing
- COPD is under-diagnosed and under-treated
- In middle and high-income countries, smoking is the major cause of COPD, but in low-income countries exposure to indoor air pollution, such as the use of biomass fuels for cooking and heating, causes the COPD burden
- 3 billions at risk.
24
Q
What are the issues of COPD in LMIC’s? (PART 2)
A
- 3 million deaths from COPD worldwide – 90% in LMIC
- COPD is increasing in prevalence worldwide - Total deaths from COPD are projected to increase by more than 30% in the next 10 years
- Estimated that COPD will be third leading cause of death worldwide in 2030
25
What are the issues of COPD in LMIC’s? (PART 3)
- Increasing exposure to risk factors especially smoking among women in LMIC
- Changing demographics with populations in LMIC with greater life expectancies and more people reaching the COPD age range
- Individuals living in LMICs have a range of unique risk factors for COPD over their lifespan. Intrauterine and early childhood exposures such as nutritional deficiencies and recurrent respiratory infections can attenuate maximal lung function development, thus accelerating the time point at which…
26
Summarise this section
- Chronic obstructive pulmonary disease is irreversible airways disease associated with progressive loss of lung volume
- Primarily caused by tobacco smoke and indoors and outdoors air pollution
- Generally associated with elements of both chronic bronchitis and emphysema
- Increasing worldwide as cause of death and morbidity
- Diagnosis based on symptoms and spirometry
