10 - COPD Flashcards
What are the charatereistics of COPD
Airflow obstruction
Progressive
Not reversible (<15% unlike asthma)
Aetiology of COPD
Smoking: passive and active
alpha anti-trypsin deficiency
TNF alpha polymorphisms
Cannabis
Coal and other dusts
Typical presentation with COPD
> 35 years
Exerstional breathlessness
Chronic cough
Sputum production
Winter exacerbations
polyphonic wheeze
What is the definition for airflow obstruction
Post bronchodilator function of < 70% FEV1 / FVC
What changes occur to the FEV1 and the FVC in obstructive lung disease?
Reduction in FEV1
Same or reduced FVC
What changes occur to the FEV1 and the FVC in restrictive lung disease?
Reduction of FEV1 and a reduction in FVC
How is the severity of COPD measured?
Using GOLD stages using FEV1
What are the stages for GOLD and COPD?
1 - >80%
2 - > 50%
3 - > 30 %
4 - < 30%
With a FEV1/FEV < 0.7
What complication can occur with COPD?
Right sided heart failure
Exacerbations
Pneumonia
Peripheral neuropathy
Cachexia
What is the pathology behind Cor pulmonale?
hypoxia leads to vasoconstriction in the lung vessels. This increases the pulomary pressure leading to increased strain on the right side of the heart. Ultimatly this leads to right sided heart failure.
What is the aetiology of exacerbation of COPD?
50% viral infection - rinovirus
50% bacterial infection - most commonly heamophillis influenza
What a CXR show with COPD?
Hyperinflation of the lungs
Low and flat diaphragms
New shadowing on lungs may show pneumonia rather than exacerbation
COPD can lead to compensated T2 respiratory failure. How would this look on an ABG?
Low O2
Raised CO2
Compensated HCO3- (metabolic)
Overall normal pH
What feature may be seen on examination that would indicate COPD?
Tar staining
Central cyanosis
Tachyopnea
Barrel chested - increased verticle expansion
Reduced vesicular sounds
Wheeze
Palpable liver
What histological feature occur in COPD?
Increased lymphocyte infiltration
Goblet cell hyperplasia
Alveolar destruction adn narrowing
What is the first line treatment for COPD?
Smoking cessation:
Nicotine replacemetns
Bupropion
Nicotine blockers
What is the 2nd line for COPD?
Bronchodilators
SABA or SAMA
What is the 3rd line for COPD?
Add
LAMA
if > 50% FEV1 = LABA
if < 50% FEV1 = LABA + ICS
What is the 4th line for COPD?
LABA + LAMA + ICS
What is salbutamol?
SABA
What is Terbutaline?
SABA
What is ventoline?
SABA - salbutamol
SE of ß2 - agonist
Tachycardia
arrythmias
exacerbate MI
muscular tremoor
paradoxical bronchospasm
hypokaleamia
What is ipatropium?
SAMA
What is atrovent?
Ipatropium - SAMA
What is tiotropium?
LAMA
What is spiriva?
Tiotropium - LAMA
SE of muscarinic antagonists?
dry mouth
nausea
headache
What conditions may be cautioned with muscarinic antagonsits?
Glucoma
Prostatic hyperplasia
Bladder outflow obstruction
What is the mechanism of action of a xanthine?
Phosphodiesterase inhibitor
Stops the degredatino fo cAMP leading to bronchial smooth muscle dilation
What is aminophyline?
A Xanthine
Can be IV and modified release
What theophylline?
A Xanthine
modified release
What effect does Magnesium have in Asthma and COPD?
Bronchodilatory effect
What is Beclemethasone?
Inhaled cortidosteroid
What is prenisalone?
oral corticosteroid
What is hydrocortisone?
IV corticosteroid
What are the SE of cortidosteroids?
Oral candidiasis
Hoarsness
Adrenal suppression
Osteoperosis
Growth inhibition in children
What is Singulair?
Montelukast - leukotriene receptor antagonist
What is Omalizumab?
monoclonal antibody binds to IgE
SC injection
What is Carbocistiene?
Mucolytic - for chronic productive cough
What are the features of hypercapnia?
Dilated pupils
Bounding pulse
Hand flap
Myoclonus
Confusion
Drowsyness
Coma
What is P pulmonale as an ECG?
Peaked T waves due to right atrial enlagment
What other ECG changes maybe seen with cor pulmonale?
Tachycarida - irregular
Righ axis deviation
RBBB?
What is the definition of chronic bronchitis?
Cough lasting with sputum lasting for most days for 3 months in 2 consequetive year.
What are the criteria for long term oxygen use?
Terminally ill
Non-smokers with PaCO2 <7.3 for > 3 weeks
PaCO2 7.3-8 + polycythemia/pulmonary hypertension/oedema/nocturnal hypoxia
A Patient presents with an acute exacerbation of COPD. ABGs show that the patient is not retaining CO2. What sats should be aimed for?
94-98% O2 sats
A COPD exacerbations shows an ABG where the patient is retaining CO2. What sats shoudl be aimed for?
88-92% sats
Reasons to give antibiotics during in an exacerbation of COPD
SoB
purulent sputum
Temp > 38C
Consolidatio on CXR
What are the pros and cons of a Nasal canula?
easy to apply
good patient efficacy
cannot titrate O2
What are the pros and cons of a non-rebreath mask?
High O2 delivery
difficult to titrate
Remeber to inflate bag before use
What are the pros and cons of a venturi mask?
Can control and titrate O2
Patients don’t like them
Can be hard to find on a ward
How do you calculate the FiO2 of a venturi mask?
(ventruri saturation x flow) + (room air @ 20% x Flow)
Will increasing the flow of O2 through a Venturi mask increase the concentration of O2?
NO
When may a patients O2 demands need to be titrated upwards/ increased?
Ill, sepsis and infection etc.
What is Siderblastic aneamia?
Microcytic anaemia due to poor erythropoesis
Leads to increased Iron loading
How would you defficiency iron deficiency aneamia from other microcytic anaemias?
Iron deficiency anaemia doesn’t have increased ferratin/ serum ferratin (as there isn’t iron overloading) comapared to thalassaemia and sidoblastic anaemia.
Patient has microcytic anaemia but which isnt repsonsive to iron suppliments, what could it be?
Sidoblastic aneamia however very rare
What is the cause of anaemia of chronic disease?
decreased erythropoesis, decreased RBC life due to cytokines, ineffective EPO.
Most common anaemia in hostpital patients
Which food have folate?
Green vegertables
Nuts
Yeast
Liver
