COPD Flashcards
What does COPD stand for?
Chronic obstructive pulmonary disease.
What is COPD characterised and encompassed by?
· Characterised by airflow limitation that is progressive isn’t fully reversible.
· Encompasses emphysema and chronic bronchitis.
Which criteria if used for severity rating?
Global Initiative for COPD (GOLD).
What is the epidemiology of COPD?
· More common in those aged 65+.
· More common in men.
· 3rd leading cause of death worldwide by 2020 - smoking and ageing.
How is chronic inflammation involved in COPD?
· Affects central and peripheral airways, lung parenchyma and alveoli and pulmonary vasculature.
· Narrowing and remodelling of the airways.
· Increased number of goblet cells.
· Enlargement of mucus-secreting glands.
· Vascular bed changes leading to pulmonary hypertension.
Do eosinophils play a role in COPD?
In contrast to asthma, eosinophils play no role in COPD, except for occasional acute exacerbations.
What happens in emphysema?
Get elastin breakdown and loss of alveolar integrity.
What happens in chronic bronchitis?
· Ciliary dysfunction and increased goblet cell size and number - excessive mucus secretion.
· Decreased airflow, hypersecretion and chronic cough.
What is the physiological definition of COPD?
· Increased airway resistance:
- Decreased elastic recoil.
- Fibrotic changes.
- Luminal obstruction by secretions.
· Expiratory flow limitation promotes hyperinflation - hypoxia.
Which index can give a prognosis?
BODE index can give a prognosis - FEV1, weight, distance able to walk in 6 minutes, degree of SOB with activity.
What 2 factors can improve survival rate?
- Smoking cessation.
2. Oxygen supplementation.
What is the aetiology of COPD?
· Tobacco smoking:
- Responsible for 40-70% of COPD cases.
- Inflammatory response, cilia dysfunction and oxidative injury.
· Air pollution.
· Occupational exposure.
What are the risk factors associated with COPD?
· Cigarette smoking.
· Advanced age.
· Genetic factors - alpha-1 antitrypsin deficiency.
List the common signs and symptoms.
· Cough:
- Usually the initial symptom.
- Frequently a morning cough, but becomes constant as the disease progresses.
- Usually productive.
· SOB:
- Initially with exercise but may progress to at rest.
- Difficulty speaking in full sentences.
· As a result of hyperinflation and air trapping secondary to incomplete expiration:
- Barrel chest.
- Hyper-resonance on percussion.
- Distant breath sounds.
· Poor air movement on auscultation. · Wheezing. · Coarse crackles. · Tachypnoea. · Asterixis - hypercapnia. · Cyanosis. · Clubbing.
What investigations would you request if you suspected a patient had COPD?
· Spirometry:
- FEV1/FVC ratio <0.70. Little improvement.
· Pulse oximetry.
· ABG - hypercapnia, hypoxia and respiratory acidosis are signs of impending respiratory failure.
· CXR.
· FBC - may show raised haematocrit (polycythaemia).
· ECG.
· Sputum culture.
· Sleep study.
Differentials?
· Asthma. · Congestive heart failure. · Bronchiectasis. · TB. · Bronchiolitis. · Upper airway dysfunction. · Chronic sinusitis. · GORD. · ACE inhibitor use. · Lung cancer.
What are the treatment options for an acute exacerbation of COPD?
· Short-acting bronchodilator - salbutamol, ipratropium. · Systemic corticosteroid. · Airway clearance techniques. · Supplemental oxygen. · Oral abx. · Non invasive and invasive ventilation.
What are the treatment options for patients with only a few symptoms?
· Short or long-acting bronchodilator.
· Patient education and smoking cessation.
What are the treatment options for patients with more symptoms?
· Short or long-acting bronchodilator.
· Patient education and smoking cessation. · · Long-term oxygen therapy.
· Theophylline or aminophylline.
· Dual long-acting bronchodilator therapy.
· Inhaled corticosteroids.
· Palliative care.
· Long-acting muscarinic antagonist.
Complications?
· Cor pulmonale:
- Right-sided heart failure.
- Caused by chronic hypoxia and subsequent vasoconstriction in pulmonary vasculature.
- Engorged neck veins, lower-extremity oedema and hepatomegaly.
· Recurrent pneumonia. · Depression. · Pneumothorax. · Respiratory failure. · Anaemia. · Polycythaemia.
What two drugs should you prescribe together in a COPD patient?
ICS + LABA/LAMA.
