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Respiratory > 1: COPD > Flashcards

1: COPD Flashcards

1
Q

What is COPD

A

Chronic condition characteristic by airway obstruction with little or no reversibility

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2
Q

What two conditions comprise COPD

A

Emphysema

Chronic bronchitis

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3
Q

Define emphysema

A

Dilation pulmonary air spaces distal to the terminal bronchioles

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4
Q

Define chronic bronchitis

A

Presence of cough for at least 3-months each year for at least two consecutive years

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5
Q

In which gender is COPD more common

A

Male

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6
Q

What are 4 risk factors for COPD

A
  • Smoking (90%)
  • Air pollution
  • Occupational exposure
  • Recurrent infections
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7
Q

What two genetic conditions increase risk of COPD

A

A1 anti-trypsin deficiency

Kartenger syndrome

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8
Q

When should a1-anti trypsin deficiency be suspected

A
  • COPD in patient under 45 years
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9
Q

What does a1 anti-trypsin deficiency also cause

A

Hepatocellular carcinoma

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10
Q

What is kartenger syndrome

A

Primary ciliary dyskinesia

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11
Q

What is kartenger syndrome associated with

A

Situs invertus

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12
Q

What pack-years increases risk of COPD by 80-90%

A

30 pack years

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13
Q

What are symptoms of COPD

A
  • Productive cough worse in mornings
  • Exertional dyspnoea then becomes chronic dyspnoea
  • Wheeze
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14
Q

What are signs of COPD

A
  • Pursed lip breathing
  • Barrel chest
  • Use accessory muscles
  • Reduced cricosternal distance (less than 3cm)
  • Decrease chest expansion
  • Hyper-resonant
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15
Q

What is NOT a sign of COPD

A

Nail clubbing

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16
Q

If a person with COPD has nail clubbing, what should be suspected

A

Lung cancer

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17
Q

What does chronic hypoxia in COPD cause

A

Pulmonary HTN

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18
Q

What is the risk with pulmonary hypertension

A

Puts strain on right-side of the heart leading to cor pulmonale

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19
Q

How does cor pulmonate present

A
  • Distent neck veins
  • Peripheral Oedema
  • Hepatomegaly
  • Parasternal Heave
  • Loud P2
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20
Q

How was COPD divided

A

Pink puffers

Blue Bloaters

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21
Q

What condition dominated in pink puffers

A

emPhysema = Pink Puffers

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22
Q

What pathology underlies pink puffers

A

Increased alveolar ventilation

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23
Q

Explain ABG in pink puffers

A

Normal PaO2 and PaCO2

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24
Q

What condition predominated in blue bloaters

A

Bronchitis

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25
Q

Describe pathophysiology of blue bloaters

A

Decrease alveolar ventilation

26
Q

What Gas abnormality is present in blue bloaters

A

Low Oxygen

High CO2

27
Q

Explain clinical presentation of blue bloaters

A

Cyanosed but not breathless

28
Q

Explain clinical presentation of pink puffers

A

Breathless, but not cyanosed

29
Q

What is typically first-investigation of COPD

30
Q

When should COPD be suspected clinically

A

patients over 35 with a risk factor (smoking) and one of:

  • productive cough
  • wheeze
  • regular sputum
  • exertional dyspnoea
31
Q

What test is used to confirm COPD

A

Spirometry

32
Q

What criteria is used to grade COPD based on spirometry

A

GOLD criteria

33
Q

What is stage I (Mild COPD)

A

FEV/FVC <0.7. FEV1 >80%

34
Q

What is stage 2 (Moderate COPD)

A

FEV/FVC <0.7. FEV1: 50-80%

35
Q

What is stage 3 (Severe COPD)

A

FEV/FVC <0.7. FEV1: 30-50%

36
Q

What is stage 4 (Very Severe COPD)

A

FEV/FVC <0.7. FEV1: <30%

37
Q

Why is a CXR usually performed in COPD

A

Exclude lung cancer

38
Q

What may be seen on CXR in COPD

A
  • Bullae

- Flat hemidiaphragm

39
Q

What can be seen on FBC in COPD

A

Flattened hemidiaphragm

Bullae

40
Q

Why is BMI measured in COPD

A

Due to other RF for CVD

41
Q

What conservative management is offered to all patients with COPD

A
  1. Smoking cessation
  2. Pulmonary Rehabilitation = offered to all individuals that see themselves as functionally disabled by COPD
  3. Pneumococcal, Influenza vaccine
42
Q

What is first-line management for COPD

A

SABA or SAMA

43
Q

What decides second stage management of COPD

A

Whether an individual has features of steroid responsiveness

44
Q

What are 4-features of steroid responsiveness

A
  1. High eosinophils
  2. Previous asthma diagnosis
  3. FEV1 varies by more than 400ml over time
  4. Diurnal variation PEF by 20%
45
Q

If individuals have features of steroid responsiveness what is given second-line

A

LABA and ICS

46
Q

If individuals do not have features of steroid-responsiveness, what is given second line

A

LABA and LAMA

47
Q

What is third-line for COPD

A

LABA, LAMA, ICS

48
Q

What is fourth line for COPD

A

Theophylline

49
Q

What antibiotics are given in COPD

A

Azithromycin

50
Q

What should be performed before azithromycin and why

A

ECG - as macrolide can increase QT interval

51
Q

What is considered in individuals with chronic productive cough

A

Mucolytics

52
Q

What may be given if severe dyspnoea

A

LTOT (Long-Term Oxygen Therapy)

53
Q

What is indication for lung volume reduction surgery

A

If dyspnoea is affecting the persons life and bull occupies more than a 1/3 on CT-scan

54
Q

When considering LTOT what is step-1

A

Assess patient

55
Q

When is a patient assessed for LTOT

A
  • PEF less than 30 (Considered if 30-50)
  • Polycythaemia
  • Peripheral Oedema
  • Raised JVP
  • Oxygen saturations less than 92%
56
Q

Describe assessing a patient for LTOT

A

Assessment is made by ABG on two occasions at-least 3 weeks apart

57
Q

What are the criteria for LTOT

A
  1. PaO2 less than 7.3kPa
  2. PaO2 of 7.3-8kPa and one of:
    - Secondary polycythaemia
    - Pulmonary HTN
    - Peripheral Oedema
58
Q

If individual has PaO2 of 7.3-8 what other criteria must be met for LTOT

A

One Of:

  • Polycythaemia
  • Pulmonary HTN
  • Peripheral Oedema
59
Q

When should LTOT NOT be offered

A

If individual continues to smoke despite smoking cessation services offered

60
Q

What 3 factors improve survival in COPD

A

LTOT

Lung volume reduction surgery

Smoking cessation

61
Q

What are 4 complications of COPD

A 
Infective exacerbation 
Pneumothorax 
Pulmonary HTN
Cor Pulmonale 
Polycythaemia

Respiratory (19 decks)

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