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Year 2 CSI > COPD II > Flashcards

COPD II Flashcards

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
Q

What is key when living with COPD?

A 
Take your medicine 
Stop smoking
Exercise regularly
Maintain a healthy weight
Get vaccinated
Check the weather
Watch what you breathe
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26
Q

What symptoms do Mr Craven present with?

A 
Phlegm and sputum (2 egg cups a day)
SOB on going up stairs
Chesty cough
Low appetite
Swelling in ankles
Temp - 37.9
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27
Q

What medication does Mr Craven take for his COPD?

A

Combo inhlaer

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28
Q

What does the Doctor diagnose Mr Craven with?

A

Infective exacerbation of his COPD

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29
Q

What are the next investigations the doctor suggests?

A 
Examine
Bloods
COPD
ABG test
ECG
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30
Q

What are the co-morbidities of COPD that could be contributing to Mr Craven’s SOB?

A 
Infection
Cardiovascular disease e.g. hypertension, coronary artery disease 
Anxiety
Depression
Cancer
Diabetes
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31
Q

What are the knock on effects of a COPD exacerbation?

A 
Decreased lung function
Decreased physical activity
Decreased mental health
Decreased QoL
Increased further COPD exacerbations
Mortality?
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32
Q

What is the association between mortality and COPD exacerbation?

A

1 in 5 patients will die in 1 year after their first COPD exacerbation

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33
Q

What COPD co-morbidities are closely associated with death?

A

Anxiety
Oesophageal cancer
Breast cancer
Lung cancer

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34
Q

What differences are seen on Mr Cravens X-ray now?

A 
Hyper-inflated lungs
Raised clavicles
Flattened diaphragm
Enlarged heart
Opacification - right lower zone
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35
Q

What is the likely diagnosis for Mr Craven?

A

Pneumonia

‘Opacification - right lower zone’

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36
Q

What are are silhouette signs?

A

Loss of silhouette
Less clarity
Cannot see outlines of structures e.g. hemidiaphragm and heart

37
Q

What other features of a COPD exacerbation can be seen on a CXR?

A 
Lung tumour (white mass)
Pleural effusion (large area of white, suggestive of fluid in the lung)
38
Q

What does Mr Craven’s ABG show?

A

Uncompensated respiratory acidosis with hypoxemia

Low O2 - hypoxemia
High CO2 - hypercarbia
Low pH - acidotic
Normal BE

39
Q

What must you remember to do when noting down an ABG?

A

Say what they are breathing e.g. room air, 2L O2 etc.

40
Q

What are the features of hypoxemic respiratory failure?

A

Type ARF
Lung Failure
O2 Low
Failure of oxygenation does not meet metabolic needs

41
Q

What causes hyp

A

R-L shunt
V/Q mismatch
Alveolar hypoventilation

42
Q

What are the features of hypercapnic respiratory failure?

A

Type II ARF

Failure of the lungs to eliminate adequate CO2

43
Q

What causes hypercapnic resp failure?

A

Pump failure

R-L shunt

44
Q

What are the organs doing to restores acid base balance?

A

Lungs respond to metabolic disorder

Kidneys respond to respiratory disorder

45
Q

What conditions cause Type I respiratory failure?

A 
Pneuomnia
Pulmonary oedema 
Pumonary embolism
Pulmonary fibrosis
Aspiration 
Lung collapse
Asthma
Pnuemothorax
Pulmonary contusion

Lung tissue unable to keep up

46
Q

What conditions cause Type II respiratory failure?

A 
Reduced respiratory drive e.g. drug overdose, head injury
Upper airway obstructions
Late severe acute asthma
COPD
Peripheral neuromuscular disease
Flail chest injury 
Exhaustion
47
Q

What drugs would you use in Mr Cravens initial management?

A

inhaled beta 2 agonists inhaled anticholinergics
antibiotics - look are previous cultures
systemic corticosteroids - IV hydrocortisone
Oxygen therapy

48
Q

What non-drug treatment would you use in Mr Cravens initial managment?

A

Sit them upright to release pressure

Respiratory physiotherapy to remove secretions clogging up the airways

49
Q

What are the two types of ventilation support?

A

CPAP

NIV (BiPAP)

50
Q

What is CPAP?

A

Continuous positive airway pressure

51
Q

What is BiPAP?

A

NIV - non invasive ventilation

Bi-level positive airway pressure

52
Q

What type of ventilation would you give Mr Crave?

A

BiPAP

Provides ventilatory support at 2 pressures so aids with inhalation and exhalation

Reduces the work of breathing

53
Q

What are the features of CPAP?

A

Gives a continuous positive airway pressure

Trying to force Oxygen in - overcome obstruction

54
Q

What are the features of BiPAP?

A

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

55
Q

What are the key features of ventilation?

A

Time
Pressure
Frequency

56
Q

Why are Mr Craven’s ankles swollen?

A

Alveolar hpoxia

Hypooxic vasoconstriction

Pulmonary vascular resistance

Pulmonary hypertension

Right ventricular afterload

Right ventricular failure

Peripheral oedema

Swelling of ankle and feet

57
Q

How does COPD affect patients?

A

Every part of your daily living

Have to think about every breathe you take

Wake up feeling awful and as if you will not achieve anything

58
Q

What can make the lives of those with COPD easier?

A 
Blue badge
Taxi card
Oxygen 
Gentle exercise once a week
BLF Helpline
Family support
Volunteering
59
Q

What are the 4 steps to interpret a ABG?

A

pH - acidic, alkalotic, normal

Primary disturbance - respiratory (O2) or respiratory (CO2)?

Is there a anion gap? (Base excess)

Is there any compensation?

60
Q

What causes respiratory acidosis?

A

CO2 level rises and patient cannot increase respiratory drive

Increased in carbonic acid formation

Decreases pH

61
Q

What causes respiratory alkalosis?

A

Hyperventilation
CO2 levels fall
Less carbonic acid
Increased pH

62
Q

What is the buffering role of bicarbonate ions in the blood?

A

React with Hydrogen ions to form water

63
Q

What is the role of the Kidneys in acid-base regulation?

A

Regulate reabsorption of bicarbonate ions esp. in PCT

Form bicarbonate ions through excretion of ammonia and monophosphate ions

Increase H+ secretion and higher pH

64
Q

What is the importance of bicarbonate ions?

A

Marker of metabolic homeostasis

Low bicarb = metabolic acidosis

High bicarb = metabolic alkalosis

65
Q

What causes a high anion gap?

A

Increase in unmeasured anions

Hydrogen ions reacting with the bicarbonate ions

Causes commonly by metabolic acidosis

66
Q

What are common causes of high anion gap metabolic acidosis?

A

Lactic acidosis
Ketoacidosis
Toxins
Renal failure

67
Q

What happens in a normal anion gap?

A

Lost bicarbonate ions are replaced with chloride ions

Commonly due to: Diarrhoea
Renal tubular acidosis

68
Q

What are the two methods of compensation?

A

Adjustments to ventilation

Adjustments to kidney absorption and excretion

69
Q

What happens metabolic acidosis to compensate?

A

Ventilation increases driving off CO2

Reduces carbonic acid in blood

Increase pH

70
Q

What are the compensatory mechanisms in metabolic alkalosis?

A

Hypoventilation is less pronounced

Rarely retains CO2 beyond 7.5 kPa

71
Q

What is the compensatory mechanism for respiratory acidosis?

A

Kidneys attempt to retain more bicarb and excrete more H+

Takes place over several days

72
Q

What is ARDS?

A

Acute respiratory distress syndrome

73
Q

What is the criteria for awake prone positioning?

A

In patients requiring and FiO2 > 28%

74
Q

What is the rationale behind prone postitioning?

A

Reduce:
ventilation/perfusion mismatching
hypoxaemia
shunting

75
Q

What does prone positioning do?

A

Decreases the pleural pressure gradients between dependent and non-dependent lung regions

76
Q

How does prone positioning help?

A

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

77
Q

What is further contributing to incidence of COPD?

A

Environmental pollutants

78
Q

What increases environmental pollutants in developing countries?

A

Use of biomass fuel for domestic energy

e.g. dung cakes, residues from crop, firewood

79
Q

What leads to inefficient gas exchange in COPD?

A

Alveolar dead space

80
Q

What does inefficient gas exchange lead to?

A

Ventilation perfusion mismatch

81
Q

What does the body do to retain the V/Q ratio?

A

localised vasoconstriction in the affected lung areas that are not oxygenated well

82
Q

What causes hypercapnia in COPD patients?

A

patients have a reduced ability to exhale the carbon dioxide adequately

83
Q

What does chronic CO2 elevation lead to?

A

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

84
Q

What is the target O2 sats for COPD patients?

A

88% to 92%

85
Q

What is the hasselbach equation?

A

pH = 6.1 + log − HCO3/0.03pCO2

86
Q

What is the significance of COPD patients with renal failure and COPD exacerbation?

A

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

87
Q

Why do you not want sats above 92% in COPD?

A

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.

88
Q

How can hypercarbia related complications be prevented?

A

Careful monitoring and proper management of COPD
Smoking cessation
Healthy lifestyle and regular exercise help prevent diseases that can worsen respiration

Year 2 CSI (8 decks)

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