COPD II Flashcards

(88 cards)

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 symptoms do Mr Craven present with?
``` Phlegm and sputum (2 egg cups a day) SOB on going up stairs Chesty cough Low appetite Swelling in ankles Temp - 37.9 ```
27
What medication does Mr Craven take for his COPD?
Combo inhlaer
28
What does the Doctor diagnose Mr Craven with?
Infective exacerbation of his COPD
29
What are the next investigations the doctor suggests?
``` Examine Bloods COPD ABG test ECG ```
30
What are the co-morbidities of COPD that could be contributing to Mr Craven's SOB?
``` Infection Cardiovascular disease e.g. hypertension, coronary artery disease Anxiety Depression Cancer Diabetes ```
31
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? ```
32
What is the association between mortality and COPD exacerbation?
1 in 5 patients will die in 1 year after their first COPD exacerbation
33
What COPD co-morbidities are closely associated with death?
Anxiety Oesophageal cancer Breast cancer Lung cancer
34
What differences are seen on Mr Cravens X-ray now?
``` Hyper-inflated lungs Raised clavicles Flattened diaphragm Enlarged heart Opacification - right lower zone ```
35
What is the likely diagnosis for Mr Craven?
Pneumonia | 'Opacification - right lower zone'
36
What are are silhouette signs?
Loss of silhouette Less clarity Cannot see outlines of structures e.g. hemidiaphragm and heart
37
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) ```
38
What does Mr Craven's ABG show?
Uncompensated respiratory acidosis with hypoxemia Low O2 - hypoxemia High CO2 - hypercarbia Low pH - acidotic Normal BE
39
What must you remember to do when noting down an ABG?
Say what they are breathing e.g. room air, 2L O2 etc.
40
What are the features of hypoxemic respiratory failure?
Type ARF Lung Failure O2 Low Failure of oxygenation does not meet metabolic needs
41
What causes hyp
R-L shunt V/Q mismatch Alveolar hypoventilation
42
What are the features of hypercapnic respiratory failure?
Type II ARF | Failure of the lungs to eliminate adequate CO2
43
What causes hypercapnic resp failure?
Pump failure | R-L shunt
44
What are the organs doing to restores acid base balance?
Lungs respond to metabolic disorder | Kidneys respond to respiratory disorder
45
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
46
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 ```
47
What drugs would you use in Mr Cravens initial management?
inhaled beta 2 agonists inhaled anticholinergics antibiotics - look are previous cultures systemic corticosteroids - IV hydrocortisone Oxygen therapy
48
What non-drug treatment would you use in Mr Cravens initial managment?
Sit them upright to release pressure Respiratory physiotherapy to remove secretions clogging up the airways
49
What are the two types of ventilation support?
CPAP | NIV (BiPAP)
50
What is CPAP?
Continuous positive airway pressure
51
What is BiPAP?
NIV - non invasive ventilation | Bi-level positive airway pressure
52
What type of ventilation would you give Mr Crave?
BiPAP Provides ventilatory support at 2 pressures so aids with inhalation and exhalation Reduces the work of breathing
53
What are the features of CPAP?
Gives a continuous positive airway pressure Trying to force Oxygen in - overcome obstruction
54
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
55
What are the key features of ventilation?
Time Pressure Frequency
56
Why are Mr Craven's ankles swollen?
Alveolar hpoxia Hypooxic vasoconstriction Pulmonary vascular resistance Pulmonary hypertension Right ventricular afterload Right ventricular failure Peripheral oedema Swelling of ankle and feet
57
How does COPD affect patients?
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
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 ```
59
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?
60
What causes respiratory acidosis?
CO2 level rises and patient cannot increase respiratory drive Increased in carbonic acid formation Decreases pH
61
What causes respiratory alkalosis?
Hyperventilation CO2 levels fall Less carbonic acid Increased pH
62
What is the buffering role of bicarbonate ions in the blood?
React with Hydrogen ions to form water
63
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
64
What is the importance of bicarbonate ions?
Marker of metabolic homeostasis Low bicarb = metabolic acidosis High bicarb = metabolic alkalosis
65
What causes a high anion gap?
Increase in unmeasured anions Hydrogen ions reacting with the bicarbonate ions Causes commonly by metabolic acidosis
66
What are common causes of high anion gap metabolic acidosis?
Lactic acidosis Ketoacidosis Toxins Renal failure
67
What happens in a normal anion gap?
Lost bicarbonate ions are replaced with chloride ions Commonly due to: Diarrhoea Renal tubular acidosis
68
What are the two methods of compensation?
Adjustments to ventilation | Adjustments to kidney absorption and excretion
69
What happens metabolic acidosis to compensate?
Ventilation increases driving off CO2 Reduces carbonic acid in blood Increase pH
70
What are the compensatory mechanisms in metabolic alkalosis?
Hypoventilation is less pronounced | Rarely retains CO2 beyond 7.5 kPa
71
What is the compensatory mechanism for respiratory acidosis?
Kidneys attempt to retain more bicarb and excrete more H+ Takes place over several days
72
What is ARDS?
Acute respiratory distress syndrome
73
What is the criteria for awake prone positioning?
In patients requiring and FiO2 > 28%
74
What is the rationale behind prone postitioning?
Reduce: ventilation/perfusion mismatching hypoxaemia shunting
75
What does prone positioning do?
Decreases the pleural pressure gradients between dependent and non-dependent lung regions
76
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
77
What is further contributing to incidence of COPD?
Environmental pollutants
78
What increases environmental pollutants in developing countries?
Use of biomass fuel for domestic energy | e.g. dung cakes, residues from crop, firewood
79
What leads to inefficient gas exchange in COPD?
Alveolar dead space
80
What does inefficient gas exchange lead to?
Ventilation perfusion mismatch
81
What does the body do to retain the V/Q ratio?
localised vasoconstriction in the affected lung areas that are not oxygenated well
82
What causes hypercapnia in COPD patients?
patients have a reduced ability to exhale the carbon dioxide adequately
83
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
84
What is the target O2 sats for COPD patients?
88% to 92%
85
What is the hasselbach equation?
pH = 6.1 + log − HCO3/0.03pCO2
86
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
87
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.
88
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