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Flashcards in COPD Deck (30):
1

What is the key difference between asthma and COPD?

Asthma is fully reversible obstruction whereas COPD is not

2

What is the FEV1/FVC in patients with COPD?

Always less than 0.7

3

COPD is graded in it's severity by what?

FEV1 starting at mild which is grade 1 which is less than 80%

4

What is grade 2 COPD

Moderate with an FEV1 of 50-79%

5

What is stage 3

Severe and there is a FEV of 30-49%

6

What is the 4th and final grade

Very severe accompanies an FEV1 of >30%

7

COPD is an umbrella for which two diseases?

Chronic bronchitis and emphysema

8

What other factors differentiate COPD from asthma?

COPD patients: over 35, persistent and productive cough, almost always caused by smoking, breathlessness progressive and persistant, no nocturnal symptoms unless severe, FMH uncommon, atopic co-conditions less likely

9

When can COPD appear at earlier ages?

In hereditary alpha 1 antitrypsin deficiency. (It is normally responsible for protecting connective tissue breakdown by neutrophil elastase)

10

What are the main pathological features of COPD?

Mucous hyperseceretion, tissue destruction, impaired repair and defence mechanisms causing small airway inflammation and fibrosis

11

What does the fibrosis and inflammation of the small airways lead to?

Increased resistance, reduced compliance, air trapping and progressive airway obstruction

12

What is emphysema?

Histologically enlarged air spaces distal to terminal bronchioles and destruction of alveolar walls reducing total surface area of the lungs for exchange

13

What is chronic bronchitis?

Cough and sputum production on most days of 3 months of a year for at least 2 consecutive years

14

Prevalence of COPD?

10-20% of over 40s

15

What are pink puffers? (Emphysema patients)

Patients with high alveolar ventilation, near normal PO2, normal or low PCO2, they are breathless but not cyanosed

16

What might pink puffers progress to?

Type 1 respiratory failure where there is hypoxia (PaO2 of

17

What are blue bloaters? (Chronic bronchitis)

Hypoxia, hypercapnic, high resp rate, raised Hb, oedema, cardiomegaly, use of accessory breathing muscles progresses to type 2 respiratory failure

18

With emphysema patients especially, (low PCO2) means breathing is driven by hypoxia therefore what should you be careful doing?

Giving oxygen as it may cause respiratory arrest

19

What are the signs of COPD?

Tachypnoea, use of accessory muscles, hyperinflation, decreased circosternal space, quiet breath sounds, cyanosis, cor pulmonale.

20

What is cor pulmonale

Right ventricular dilatation and consequent fluid retention as a result of increased resistance for blood entering the pulmonary circulation increasing after load

21

What investigations must be done?

Spirometry, ABGs, CXR, FBC (showing increased PCV and haemocrit of >55%), echocardiogram to confirm RV dilatation in cor pulomonale

22

What lifestyle advice and general help would you give to those with chronic COPD?

Smoking cessation, weight loss, influenza and pneumococcal vaccination,

23

What drug might you give as a general measure if required?

Short acting beta agonist and ipratropium bromide

24

If moderate give what?

Long acting anti-muscarinic (tiotropium) or beta 2 agonist

25

If severe give what?

Long acting beta agonist and corticosteroid

26

If the patient remains symptomatic after grade 3 treatment do what?

Give tiotropium, inhaled steroid, beta agonist and refer to specialist

27

Non smokers can receive what if symptoms persist and PO2 below 7.4

Long term oxygen therapy (LTOT)

28

Complications of COPD

Exacerbations, polycythemia, respiratory failure, cor pulmonale, pneumothorax, carcinoma

29

General steps for exacerbation of COPD are?

Nebulised bronchodilators, controlled O2 therapy aiming 88-92%, antibiotics, steroids

30

COPD is characterized by what?

Airway obstruction with little or NO REVERSIBILITY