What is the mechanism of action of tiotropium (spiriva)
It's an anticholinergic - Blocks M3 muscarinic receptors on smooth muscle cells and submucosal glands to reduce bronchocontriction and mucus secretion
Why does lung reduction surgery help in COPD?
Bad lung impinges on good lung
In which airways does inflammation generally occur? What is the consequence?
Fibrosis and obliterative bronchiolitis
What are some side effects of anticholinergics?
A progressive condition of irreversible airflow limitation due to an ongoing, abnormal inflammatory response to noxious stimuli
Describe 4 microscopic aspects of the COPD pathophysiology
Destruction of alveolar septa
Loss of elasticity
Inflammatory cell infiltrate - Neutrophils, macrophages, CD8+
Destruction of pulmonary capillary bed
What are some long acting beta2 agonists used in COPD?
Indacaterol (ultra long acting)
Name some anticholinergics used in COPD (including tradenames)?
What is chronic bronchitis?
Inhalation of a noxious stimulus that causes production of mucus chronically
What therapies can be used in exacerbations?
What is seratide a combination of?
Salmeterol and fluticasone
How do you make the diagnosis of COPD?
When are inhaled corticosteroids indicated in COPD?
What is the benefit of oxygen home therapy?
Reduces pulmonary hypertension
Why might FVC be low in COPD lungs?
What are some physical signs of COPD?
Hyperresonance to purcussion
Dull breath sounds
Describe the epidemiology of COPD
3rd leading cause of disease burden in Aus
500,000 Australians have moderate COPD
By what factor is FER reduced for COPD to be diagnosed?
FER = <0.7
(FER = FEV1 / FVC)
What is pulmonary rehabilitation?
Patients develop mastery of their airways
How does the pattern of inflammation differ in asthma cf COPD?
Inflammation affects all airways in asthma
Fibrosis isn't a major factor in asthma cf in COPD where it is
In terms of cell type, what type of inflammation in present in COPD?
By what method is the severity of COPD graded?
Percentage of predicted FEV1
What are some pharmalogical methods of smoking cessation?
When are inhaled steroids indicated in COPD?
When the disease is severe with an FEV1 <50% predicted
What is symbicort?
Budesonide and formoterol
When is home oxygen therapy indicated?
When PaO2 is <55mmHg or <60mmHg with hypoxic symptoms
No cigarettes for 3 months
What are some causes of exacerbations of COPD?
Any increase in basal metabolic rate