Week 103 - COPD Flashcards Preview

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Flashcards in Week 103 - COPD Deck (15):
1

what is COPD

a disease causing Airway obstruction that is not fully reversible there are two parts to COPD bronchitis and emphysema

2

what is chronic bronchitis

cough producing purulent sputum for greater than 3 months for two consecutive years
it involves the inflammation and narrowing of the Airways this is due to infiltration of neutrophils and cytotoxic T cells that lead to the fibrosis of the bronchi
there is increased and thick mucus this is due to the hypertrophy of goblet cells
squamous metaplasia release results in the loss of cilia

3

what is emphysema

dilation and destruction of the lung tissue distal to Terminal bronchioles results in a loss of elasticity due to fibrosis
on expiration it is not possible to keep the airways open which results in airflow limitation and air trapping
inflammation is due to the infiltration of neutrophils and cytotoxic T cells into the epithelium
inflammatory cells release proteases which results in the breakdown of collagen and elastin resulting in loss of elasticity

4

what are pink puffers

is patients usually have more emphysema and an increasing alveolar ventilation
these patients present very breathless and may have muscle wastage and intercostal recession

5

what are blue bloaters

these patients have more bronchitis and a decrease in alveolar ventilation
these patients have signs of CO2 retention which includes bounding pulse and flapping tremor they also can be diagnosed and oedematus

6

what are the causes of COPD

smoking and pollutants can cause COPD which impacts the upper lobe of the lungs
alpha-1 antitrypsin deficiency can result in COPD in younger patients and this impacts the lower lobe of the lung

7

what are the signs and symptoms of COPD caused by smoking and pollutants

age of onset is usually greater than 35
production of purulent sputum
wheeze and breathlessness this is usually persistent and progressive
chest expansion is poor
lungs are hyperinflated resulting in a barrel chest
accessory muscles are usually used for breathing

8

what are 2 complications of COPD

respiratory failure this is where gas exchange is sufficiently impaired to cause hypoxia
cor pulmonale this is heart disease secondary to disease of the lung

9

what investigations can be used on a patient that as suspected COPD

lung function tests including spirometry serial peak flow monitoring and reversibility testing
chest X-ray
haemoglobin and packed cell volume
arterial blood gases

10

what does spirometry show

measure the amount of air breathed out in one forced breath
fev1 is the volume of a patient is able to exhale in the first second of forced expiration
fvc is it the total volume of air exhaled
fev1/fvc is a ratio expressed as a percentage
in COPD fev1 less than 80% and fev1/fvc ratio is less than 0.7
the severity of airflow obstruction in COPD is indicated by the reduction in fev1

11

what is peak flow

a measure of how fast you can breathe out serial peak flow monitoring can be used to determine whether there is diurnal variation there is more variation with asthmatic patients

12

what is reversibility testing

this measures the fev1 before and after the administration of a bronchodilator

13

what may you see indeed chest x-ray of a patient with COPD due to smoking or pollutants

usually the upper lobe will be impacted there will be hyperinflation of the lungs reduced peripheral lung markings and bullae

14

what are the management options for COPD

smoking cessation
bronchodilators which include beta 2 agonists and muscarinic antagonist
corticosteroids
xanthine
prevention of infection
oxygen
pulmonary rehabilitation
surgery

15

what are the two types of bronchodilators used is an example of a long acting and short acting drug for each

beta 2 agonist acts on the beta 2 adrenergic receptors in bronchial smooth muscle this results in relaxation by increasing the calcium influx into cells which stops constriction
side effects include tremor due to the action on skeletal B2 receptors and tachycardia due to the action on the B1 heart receptors
salbutamol is an example of a short acting SABA beta 2 agonist
Salmeterol an example of a long acting beta 2 agonist LABA
Mr Renwick antagonists reactivity of the muse carennac acetylcholine receptor side effects include dry mouth
ipatropium is a short acting muscarinic antagonist SAMA
tiotropium is a long acting muscarinic antagonist LAMA