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COPD Flashcards

1
Q

What is COPD?

A
  • Group of conditions lumped together, including chronic bronchitis, emphysema, bronchiolitis
  • Progressive disorder characterized by airway obstruction <80% predicted, 0.7 FEV1/FVC with little or no reversibility
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2
Q

What is COPD mainly caused by?

A

Smoking

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3
Q

What is the brief pathophysiology of chronic bronchitis?

A
  • Airway inflammation
  • Airway fibrosis, luminal plugs
  • Increased airway resistance
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4
Q

What is the brief pathophysiology of emphysema?

A
  • Loss of alveolar attachments

- Decrease of elastic recoil

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5
Q

What is the brief pathophysiology of Alpha 1 antitrypsin deficiency?

A
  • AAT is a protease inhibitor
  • It normally protects tissues from enzymes from inflammatory cells (neutrophil elastase - breaks down elastic proteins in ECM = loss of recoil)
  • Without it, a person is more susceptible to damage from smoke or fumes
  • Also affects the liver
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6
Q

What are the risk factors for COPD?

A
  • Smoking (only ⅓ of smokers will get due to genetics)
  • Pollution (indoor and outdoor)
  • Genetics
  • Infections
  • Socioeconomic Status
  • Race
  • Male dominance
  • Age - 10-20% over 40s
  • Occupation dust and chemicals
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7
Q

What are the main symptoms of COPD?

A
  • SOB
  • Cough
  • Sputum Production
  • Wheeze
  • Chronic dyspnoea
  • Minimal diurnal or FEV1 variation
  • Weight Loss
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8
Q

What are the main features of emphysema?

A

Nicknamed: pink puffers.

  • Increased alveolar ventilation
  • Near normal PaO2
  • Weight Loss
  • Cachexia
  • breathless but not cyanosed
  • May progress to type 1 respiratory failure
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9
Q

What are the main features of chronic bronchitis?

A

Nicknamed: Blue bloaters

  • Decreased alveolar ventilation
  • Low Pa02 and high PaCO2
  • Cyanosed but not breathless
  • May go on to develop cor pulmonale
  • Respiratory centres are fairly insensitive to CO2 and reply on hypoxia as the main drive for respiration - therefore you have to be careful when administering oxygen
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10
Q

What would spirometry show in a patient with COPD?

A
  • FEV1/FVC <0.7

- FVC <80% predicted

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11
Q

What would a chest xray show in a patient with COPD?

A
  • Hyperinflation
  • Flat hemidiaphragms
  • Large central pulmonary arteries
  • Decreased peripheral vascular markings
  • Bullae (complete destruction of lung tissue producing airspace >1cm)
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12
Q

What would the CT scan show in someone with COPD?

A
  • Bronchial wall thickening
  • Scarring
  • Air space enlargement (black spots in lung)
  • Different pattern of air within lung between asymptomatic and symptomatic smokers
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13
Q

What would the ECG show in COPD?

A
  • Right atrial and ventricular hypertrophy (cor pulmonale)
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14
Q

What would the ABG show in COPD?

A

Decreased PaO2 with/without hypercapnia

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15
Q

What is MRC grading?

A

It is a score used to assess how breathlessness effects daily activities

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16
Q

What is the MRC dyspnea scale grades 1-5?

A
  1. SOB on marked exertion
  2. SOB on hills
  3. Slow or stop on flat
  4. Exercise tolerance 100-200 yards on flat
  5. Housebound / SOB on minor tasks
17
Q

What is the COPD assessment test?

A

A questionnaire for people with COPD. It is designed to measure the impact of COPD on a person’s life, and how this changes over time.

18
Q

What is st george’s respiratory questionnaire?

A

Aims to find out a persons quality of life when living with COPD and asthma. Looks at other things than just lung function.

19
Q

What is the classification of COPD?

A
  1. Stage 1: FEV1 >80% (mild) [chronic cough, none/mild breathlessness]
  2. Stage 2: 50-79% (moderate) [breathlessness on exertion]
  3. Stage 3: 30-49% (severe) [breathlessness on minimal exertion]
  4. Stage 4: <30% (very severe) [breathless at rest]
    Not useful for predicting total mortality for 3 years of follow up and onwards
20
Q

What are the complications associated with COPD?

A
  • Acute exacerbations and infections
  • Polycythaemia
  • Resp failure
  • Cor Pulmonale (oedema and increased JVP)
  • Pneumothorax (ruptured bullae)
  • Lung Carcinoma
21
Q

What are some indications that a patient with COPD may need hospital admission?

A
  • Marked increase in intensity of symptoms
  • Severe underlying COPD
  • Onset of new physical signs
  • Failure of an exacerbation to respond to initial medical management
  • Presence of serious comorbidities
  • Frequent exacerbations
  • Older age
  • Insufficient home support
22
Q

What are the non-pharmacological treatments for COPD?

A
  • Smoking cessation

- Rehabilitation with the aim at increasing exercise tolerance

23
Q

What is the pharmacological treatment for COPD?

A
  • Bronchodilators
  • Inhaled corticosteroids
  • Systemic corticosteroids
  • Combination therapy (Inhaled long acting beta agonist / inhaled glucocorticosteroid + anticholinergic (eg tiotropium)
  • Oxygen therapy to patients with chronic respiratory failure
  • Ventilatory support -
24
Q

What surgical treatments can be used in COPD?

A
  • Lung volume reduction surgery (LVRS) is more efficacious than medical therapy among patients with upper lobe predominant emphysema and low exercise capacity
    Costly relative to health care programs not including surgery
  • Lung transplant in appropriately selected patients
25
Q

What is the difference in the airway inflammation in asthma and COPD?

A 
Asthma = Eosinophils 
COPD = Neutrophils
26
Q

How is the course of the disease different in COPD and asthma?

A 
COPD = progressive worsening 
Asthma = stable

Resp (8 decks)

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