What changes occur to the FEV1 and the FVC in obstructive lung disease?

Reduction in FEV1 Same or reduced FVC

10 - COPD Flashcards by Mark Brown

What are the charatereistics of COPD

Airflow obstruction

Progressive

Not reversible (<15% unlike asthma)

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Aetiology of COPD

Smoking: passive and active

alpha anti-trypsin deficiency

TNF alpha polymorphisms

Cannabis

Coal and other dusts

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Typical presentation with COPD

> 35 years

Exerstional breathlessness

Chronic cough

Sputum production

Winter exacerbations

polyphonic wheeze

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What is the definition for airflow obstruction

Post bronchodilator function of < 70% FEV₁ / FVC

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What changes occur to the FEV₁ and the FVC in obstructive lung disease?

Reduction in FEV₁

Same or reduced FVC

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What changes occur to the FEV1 and the FVC in restrictive lung disease?

Reduction of FEV₁ and a reduction in FVC

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How is the severity of COPD measured?

Using GOLD stages using FEV₁

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What are the stages for GOLD and COPD?

1 - >80%

2 - > 50%

3 - > 30 %

4 - < 30%

With a FEV₁/FEV < 0.7

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What complication can occur with COPD?

Right sided heart failure

Exacerbations

Pneumonia

Peripheral neuropathy

Cachexia

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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.

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What is the aetiology of exacerbation of COPD?

50% viral infection - rinovirus

50% bacterial infection - most commonly heamophillis influenza

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What a CXR show with COPD?

Hyperinflation of the lungs

Low and flat diaphragms

New shadowing on lungs may show pneumonia rather than exacerbation

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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

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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

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What histological feature occur in COPD?

Increased lymphocyte infiltration

Goblet cell hyperplasia

Alveolar destruction adn narrowing

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What is the first line treatment for COPD?

Smoking cessation:

Nicotine replacemetns

Bupropion

Nicotine blockers

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What is the 2nd line for COPD?

Bronchodilators

SABA or SAMA

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What is the 3rd line for COPD?

Add

LAMA

if > 50% FEV₁ = LABA

if < 50% FEV₁ = LABA + ICS

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What is the 4th line for COPD?

LABA + LAMA + ICS

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What is salbutamol?

SABA

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What is Terbutaline?

SABA

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What is ventoline?

SABA - salbutamol

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SE of ß₂- agonist

Tachycardia

arrythmias

exacerbate MI

muscular tremoor

paradoxical bronchospasm

hypokaleamia

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What is ipatropium?

SAMA

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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?

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