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COPD II Flashcards

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1
Q

What is COPD?

A

Chronic obstructive pulmonary disease (COPD) is the name for a group of lung conditions that cause breathing difficulties.

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2
Q

What does COPD include?

A

emphysema – damage to the air sacs in the lungs

chronic bronchitis – long-term inflammation of the airways

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3
Q

Who does COPD normally affect?

A

middle-aged or older adults who smoke

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4
Q

What are the main symptoms of COPD?

A

increasing breathlessness, particularly when you’re active

a persistent chesty cough with phlegm – some people may dismiss this as just a “smoker’s cough”

frequent chest infections
persistent wheezing

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5
Q

When does COPD occur?

A

when the lungs become inflamed, damaged and narrowed

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6
Q

What causes COPD?

A

Smoking
Likelihood of developing COPD increases the more you smoke and the longer you’ve smoked

Air pollution

Genetics

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7
Q

What are the treatments for COPD?

A 
Smoking cessation
Inhalers and medicines
Pulmonary rehabilitation
Surgery 
Lung transplant
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8
Q

What are less common symptoms of COPD?

A 
Weight loss
Tiredness
Swollen ankles
Chest pain
Coughing up blood
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9
Q

What fume substances have been linked to COPD?

A 
cadmium dust and fumes
grain and flour dust
silica dust
welding fumes
isocyanates
coal dust
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10
Q

What are the genetics implicated in COPD?

A

Alpha-1-antitrypsin deficiency

A substance that protects your lungs

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11
Q

How can COPD be diagnosed?

A

Spirometry
Chest X-Ray
Blood tests

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12
Q

What further test might be needed for COPD?

A 
ECG
Echocardiogram
Peak flow test
Blood oxygen test
CT Scan
Phlegm sample
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13
Q

What inhalers will most people use?

A

Short-acting bronchodilators

  • beta-2 agonists e.g. salbutamol and terbutaline
  • antimuscarinic inhalers e.g. ipratropium

can be used up to 4 times a day

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14
Q

What inhalers should you use if you experience symptoms regularly throughout the day?

A

Long-acting bronchodilators

beta-2 agonist inhalers – such as salmeterol, formoterol and indacaterol

antimuscarinic inhalers – such as tiotropium, glycopyronium and aclidinium

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15
Q

When are steroid inhalers prescribed?

A

If you’re still becoming breathless when using a long-acting inhaler, or you have frequent flare-ups

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16
Q

What tablets are used in COPD?

A

Theophylline tablets

Bronchodilator

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17
Q

What are the side effects of theophylline?

A

feeling and being sick
headaches
difficulty sleeping (insomnia)
noticeable pounding, fluttering or irregular heartbeats (palpitations)

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18
Q

What are mucolytics?

A

Mucolytic medicines make the phlegm in your throat thinner and easier to cough up.

e.g. carbocisteine 3-4 times a day

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19
Q

What could you be prescribed if you have a particularly bad flare up?

A

Short course of steroid tablets

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20
Q

When might you be prescribed antibiotics?

A

Signs of a chest infection, such as:

becoming more breathless
coughing more
noticing a change in the colour (such as becoming brown, green or yellow) and/or consistency of your phlegm (such as becoming thicker)

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21
Q

What is pulmonary rehabilitation?

A

specialised programme of exercise and education designed to help people with lung problems such as COPD

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22
Q

What does a typical pulmonary rehabilitation programme consist of?

A

physical exercise training tailored to your needs and ability – such as walking, cycling and strength exercises
education about your condition for you and your family
dietary advice
psychological and emotional support

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23
Q

What other form of treatments are available for bad cases/flare ups?

A 
Nebuliser
Roflumilast
Long-term oxygen therapy
Ambulatory oxygen therapy
Non-invasive ventilation
Surgery
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24
Q

What are the three surgical options?

A

Bullectomy
Lung volume reduction durgery
Lung transplant

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25
What is key when living with COPD?
``` Take your medicine Stop smoking Exercise regularly Maintain a healthy weight Get vaccinated Check the weather Watch what you breathe ```
26
What are the knock on effects of a COPD exacerbation?
``` Decreased lung function Decreased physical activity Decreased mental health Decreased QoL Increased further COPD exacerbations Mortality? ```
27
What is the association between mortality and COPD exacerbation?
1 in 5 patients will die in 1 year after their first COPD exacerbation
28
What COPD co-morbidities are closely associated with death?
Anxiety Oesophageal cancer Breast cancer Lung cancer
29
What is seen on CXR in COPD?
Hyper-inflated lungs Raised clavicles Flattened diaphragm Enlarged heart
30
What other features of a COPD exacerbation can be seen on a CXR?
``` Lung tumour (white mass) Pleural effusion (large area of white, suggestive of fluid in the lung) ```
31
What must you remember to do when noting down an ABG?
Say what they are breathing e.g. room air, 2L O2 etc.
32
What are the features of hypoxemic respiratory failure?
Type ARF Lung Failure O2 Low Failure of oxygenation does not meet metabolic needs
33
What causes hypoxemic respiratory failure?
R-L shunt V/Q mismatch Alveolar hypoventilation
34
What are the features of hypercapnic respiratory failure?
Type II ARF | Failure of the lungs to eliminate adequate CO2
35
What causes hypercapnic resp failure?
Pump failure | R-L shunt
36
What are the organs doing to restores acid base balance?
Lungs respond to metabolic disorder | Kidneys respond to respiratory disorder
37
What conditions cause Type I respiratory failure?
``` Pneuomnia Pulmonary oedema Pumonary embolism Pulmonary fibrosis Aspiration Lung collapse Asthma Pnuemothorax Pulmonary contusion ``` Lung tissue unable to keep up
38
What conditions cause Type II respiratory failure?
``` Reduced respiratory drive e.g. drug overdose, head injury Upper airway obstructions Late severe acute asthma COPD Peripheral neuromuscular disease Flail chest injury Exhaustion ```
39
What are the two types of ventilation support?
CPAP | NIV (BiPAP)
40
What is CPAP?
Continuous positive airway pressure
41
What is BiPAP?
NIV - non invasive ventilation | Bi-level positive airway pressure
42
What are the features of CPAP?
Gives a continuous positive airway pressure Trying to force Oxygen in - overcome obstruction
43
What are the features of BiPAP?
Delivers differing air pressures Inspiratory pressure is higher than expiratory pressure Not an equally high expiratory pressure that would increased the work of breathing Allows CO2 to be expelled Need to balance I:E ratio
44
What are the key features of ventilation?
Time Pressure Frequency
45
What can make the lives of those with COPD easier?
``` Blue badge Taxi card Oxygen Gentle exercise once a week BLF Helpline Family support Volunteering ```
46
What are the 4 steps to interpret a ABG?
pH - acidic, alkalotic, normal Primary disturbance - respiratory (O2) or respiratory (CO2)? Is there a anion gap? (Base excess) Is there any compensation?
47
What causes respiratory acidosis?
CO2 level rises and patient cannot increase respiratory drive Increased in carbonic acid formation Decreases pH
48
What causes respiratory alkalosis?
Hyperventilation CO2 levels fall Less carbonic acid Increased pH
49
What is the buffering role of bicarbonate ions in the blood?
React with Hydrogen ions to form water
50
What is the role of the Kidneys in acid-base regulation?
Regulate reabsorption of bicarbonate ions esp. in PCT Form bicarbonate ions through excretion of ammonia and monophosphate ions Increase H+ secretion and higher pH
51
What is the importance of bicarbonate ions?
Marker of metabolic homeostasis Low bicarb = metabolic acidosis High bicarb = metabolic alkalosis
52
What causes a high anion gap?
Increase in unmeasured anions Hydrogen ions reacting with the bicarbonate ions Causes commonly by metabolic acidosis
53
What are common causes of high anion gap metabolic acidosis?
Lactic acidosis Ketoacidosis Toxins Renal failure
54
What happens in a normal anion gap?
Lost bicarbonate ions are replaced with chloride ions Commonly due to: Diarrhoea Renal tubular acidosis
55
What are the two methods of compensation?
Adjustments to ventilation | Adjustments to kidney absorption and excretion
56
What happens metabolic acidosis to compensate?
Ventilation increases driving off CO2 Reduces carbonic acid in blood Increase pH
57
What are the compensatory mechanisms in metabolic alkalosis?
Hypoventilation is less pronounced | Rarely retains CO2 beyond 7.5 kPa
58
What is the compensatory mechanism for respiratory acidosis?
Kidneys attempt to retain more bicarb and excrete more H+ Takes place over several days
59
What is ARDS?
Acute respiratory distress syndrome
60
What is the criteria for awake prone positioning?
In patients requiring and FiO2 > 28%
61
What is the rationale behind prone postitioning?
Reduce: ventilation/perfusion mismatching hypoxaemia shunting
62
What does prone positioning do?
Decreases the pleural pressure gradients between dependent and non-dependent lung regions
63
How does prone positioning help?
Gravitational effects Conformational shape matching of the lung to chst cavity Generates more homogenous lung aeration and strain distribution Enhances recruitments of dorsal lung units
64
What is further contributing to incidence of COPD?
Environmental pollutants
65
What increases environmental pollutants in developing countries?
Use of biomass fuel for domestic energy | e.g. dung cakes, residues from crop, firewood
66
What leads to inefficient gas exchange in COPD?
Alveolar dead space
67
What does inefficient gas exchange lead to?
Ventilation perfusion mismatch
68
What does the body do to retain the V/Q ratio?
localised vasoconstriction in the affected lung areas that are not oxygenated well
69
What causes hypercapnia in COPD patients?
patients have a reduced ability to exhale the carbon dioxide adequately
70
What does chronic CO2 elevation lead to?
acid-base disorders and a shift of normal respiratory drive to hypoxic drive chemoreceptors develop tolerance to chronically elevated arterial carbon dioxide level shifts the normal acid-base balance toward acidic
71
What is the target O2 sats for COPD patients?
88% to 92%
72
What is the hasselbach equation?
pH = 6.1 + log − HCO3/0.03pCO2
73
What is the significance of COPD patients with renal failure and COPD exacerbation?
kidneys are unable to reabsorb bicarbonate to compensate for chronic respiratory acidosis Over time, mixed respiratory and metabolic acidosis sets in causing dangerously low levels of pH The mortality rate is much higher
74
Why do you not want sats above 92% in COPD?
The failure of the hypoxic drive Haldane effect: The increased partial pressure of oxygen in the blood displaces the carbon dioxide from hemoglobin and thereby increasing the CO2 level. The increased partial pressure of oxygen reverses the hypoxic vasoconstriction at the pulmonary artery level which leads to the blood going to areas of lungs with no ventilation. Increasing dead space and thus increasing acidosis. The increased amount of oxygen displaces nitrogen, which leads to atelectasis.
75
How can hypercarbia related complications be prevented?
Careful monitoring and proper management of COPD Smoking cessation Healthy lifestyle and regular exercise help prevent diseases that can worsen respiration

Respiratory Medicine (12 decks)

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