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Flashcards in COPD Deck (33)
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1

Describe COPD

Chronic obstructive pulmonary disease
Characterised by airflow obstruction
Obstruction is usually progressive, not fully reversible and does not change markedly over several months
Umbrella term for emphysema and chronic bronchitis

2

Describe emphysema

Pathological destruction of terminal bronchioles and alveoli
Loss of alveolar SA, impairs gas exchange
Often progresses to development of large, redundant air spaces (bullae)
Destruction of supporting tissue (collapse during expiration)
Loss of elastic tissue (tend to hyperinflate - Barrel chest)

3

Describe chronic bronchitis

Chronic mucus hypersecretion
Frequently in smokers
Inflammation in the large airways
Proliferation of mucus producing cells
Chronic productive cough
Frequent resp infections
Air flow obstruction due to remodelling

4

Name some causes of COPD

Smoking (commonest)
Alpha 1 antitrypsin deficiency
Occupational exposure (coal, dust)
Pollution

5

Approximately what percentage of smokers develop COPD?

15%

6

What are the symptoms of COPD?

Cough
Sputum production
Breathlessness

7

What is the MRC dyspnoea score?

Grade of breathlessness

8

Describe the stages of the MRC dyspnoea score

1. Not troubled except on strenuous exercise
2. Short of breath when hurrying or walking up a slight hill
3. Walks slower on level ground because of breathlessness or has to stop for breath when walking at own pace
4. Stops for breath after walking about 100m or after a few minutes on level ground
5. Too breathless to the leave the house or breathless when dressing/undressing

9

What are the signs of COPD?

Purse lip breathing
Tachypnoea
Using accessory muscles
Hyperinflation
Wheeze/reduced breath sounds
Advanced = cyanosis, CO2 retention, RH failure with oedema

10

Why does a COPD patient purse their lips on breathing?

Protective manoeuvre that increases pressure within the airways
Reduction/delay in closure therefore easier to breathe out

11

What is essential for diagnosing COPD?

A measurement of airflow obstruction
Spirometry

12

How is spirometry performed and what does it measure?

Blow out as hard and as much as possible into a sealed tube
FEV1 and FVC measured

13

Obstruction in COPD leads to a FEV1/FVC ratio of ...

< 70%

14

What ratio from spirometry would suggest mild obstruction?

50-80% predicted

15

What ratio from spirometry would suggest moderate obstruction?

30-49% predicted

16

What ratio from spirometry would suggest severe obstruction?

<30% predicted

17

What features of a Hx are most suggestive of COPD?

Smoker/ex-smoker
Older patient (>40 years)
Chronic productive cough
Breathlessness that is persistent and progressive

18

How is a COPD Hx different to asthma?

Likely to be smoker
Rare to get it <40 years
Chronic productive cough
Progressive and persistent breathlessness
Unlikely to wake you up at night
No diurnal variation

19

What investigations would we do for COPD?

CXR (mandatory to rule out other diagnoses)
CT - detailed assessment of degree of destruction
ABG - assess for resp failure
Alpha 1 antitrypsin blood test (younger people)

20

Describe the COPD care bundle (Mx)

Smoking cessation
Pulmonary rehab
Bronchodilators
Antimuscarinics
Steroids
Mucolytics
Diet supplements
Supportive things eg. Flu vaccine

21

What do we consider as management for severe COPD patients?

Long term oxygen therapy
Lung volume reduction (surgery)

22

Describe how beta 2 agonists work in obstructive diseases

Bind to beta 2 adrenoreceptors
Activates adenyl cyclase
Increased production of cAMP
Activates PKA
Phosphorylation of targets
Inhibits SM contraction
Relaxation of SM occurs

23

What are some of the adverse side effects of beta 2 agonists?

Tachycardia/palpitations
Tremor
Anxiety
Hypokalaemia

24

How do methylxanthines work?

Bronchodilation
Increased respiratory drive
Anti-inflammatory effects
Inhibition of phosphodiesterase to promote SM relaxation

25

Give some side effects of long term steroid use

Thin skin/easy bruising
Cataracts
Adrenal insufficiency
GI symptoms
Oestoporosis
Diabetes
Increased weight
Mental disturbance

26

What is pulmonary rehabilitation?

Exercise programme run at hospital
6 weeks
All supervised
Be able to walk further and easier
Give advice on disease
Peer support

27

Describe deconditioning

A viscous cycle of increasing social isolation and inactivity leading to worsening of symptoms

28

When would we offer long term oxygen therapy for COPD?

If partial pressure oxygen consistently < 7.3 kPa
Non-smokers
Not retain high levels of carbon dioxide

29

How long do you need to be on oxygen per day to confer a survival advantage?

At least 16 hours/day

30

What is the management for acute exacerbation of COPD?

Bronchodilators via nebulisers
Steroids
Abx if infective features
Consider IV aminophylline
Repeat ABG to check improvement