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CLINICAL MEDICINE > 2. COPD > Flashcards

2. COPD Flashcards

1
Q

Define C.O.P.D. and state it’s characteristics.

A

C.O.P.D. is a preventable and treatable lung disease with significant extrapulmonary effects. It is characterized as a usually progressive, not fully reversible airflow limitation.

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2
Q

What is the main cause of C.O.P.D.?

A

Noxious particles and gases, causing the lungs to initiate an abnormal inflammatory response.

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3
Q

Severe COPD leads to?

A
  1. Respiratory failure
  2. Repeated hospitalization
  3. Death
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4
Q

State the 3 primary components of COPD.

A
  1. Chronic bronchitis
  2. Emphysema
  3. Asthma
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5
Q

Define Chronic Bronchitis.

A

A productive cough for at least 3 months, in at least 2 consecutive years, with the absence of any other identifiable cause of excessive sputum production.

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6
Q

Define Emphysema.

A

Emphysema is a condition in which alveolar wall destruction is seen, leading to irreversible enlargement of air spaces.

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7
Q

What is the common site for Emphysema in the lung?

A

Distal to the terminal bronchioles

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8
Q

Is there fibrosis in Emphysema?

A

No

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9
Q

State 9 external risk factors of COPD.

A
  1. Tobacco smoke
  2. Biomass fuel smoke
  3. Open fire
  4. Chronic uncontrolled asthma
  5. Occupational dust and chemicals
  6. Infections
  7. Overcrowding
  8. Damp environment
  9. Low socioeconomic status
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10
Q

State 4 external risk factors of COPD.

A
  1. Genetics (Lack of Alpha 1 Anti-Trypsin)
  2. Hyper responsiveness
  3. Low lung growth
  4. Low birth weight
  5. Age (Old age)
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11
Q

Explain the pathogenesis of COPD.

A

The lungs initiates an abnormal inflammatory response to the noxious agents. Overtime, it leads to Small Airway Disease (Cellular infiltration, Airway remodelling) and Parenchymal Destruction (Loss of alveolar attachments, decreased elastic recoil). This causes airway limitations in the patient.

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12
Q

State 6 histological characteristics seen in a COPD bronchial architecture.

A
  1. Mucous gland hypertrophy
  2. Smooth muscle hypertrophy
  3. Goblet cell hyperplasia
  4. Inflammatory infiltrate
  5. Excessive mucous
  6. Squamous metaplasia
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13
Q

Who is a ‘Blue Bloater’ ?

A

A patient with Chronic Bronchitis

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14
Q

Who is a ‘Pink Puffer’ ?

A

A patient with Emphysema

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15
Q

State the clinical features seen in a Blue Bloater.

A
  1. Mild dysapnea
  2. Prominent cough
  3. Copious, mucoid sputum
  4. Frequent infections
  5. Cor pulmonale
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16
Q

State the clinical features seen in a Pink Puffer.

A
  1. Severe dysapnea
  2. Cough after dysapnea
  3. Scanty sputum
  4. Less frequent infections
  5. Terminal respiratory failure
17
Q

How do you grade dysapnea?

A

mMRC Grading of Dysapnea

GRADE 1 : Dysapnea only on strenuous exercise
GRADE 2 : Dysapnea when hurrying or walking up a slight hill
GRADE 3 : Walks slower than people of the same age because of dysapnea OR has to stop for a breath when walking at normal pace
GRADE 4 : Stops for a breath after walking 100m or after a few minutes
GRADE 5 : Too dyspneic to leave the house or breathless when dressing up.

18
Q

State the common signs seen in physical examination indicating COPD.

A
  1. Hyper-inflated chest, barrel chest
  2. Wheezes or quiet breathing
  3. Pursed lips/ accessory resp. muscles
  4. Peripheral oedema
  5. Cyanosis
  6. Increased JVP
  7. Cachexia
  8. Productive cough, dysapnea
19
Q

State the investigations you’d carry out to confirm your diagnosis of COPD.

A
  1. Blood counts (Haematocrit)
  2. Spirometry
  3. Chest X-Ray
  4. Arterial Blood Gases
  5. CT Scan of Thorax
20
Q

Define haematocrit.

A

The ratio of the Volume of RBCs to the Total Volume of Blood.

21
Q

What is the haematocrit of a patient with Chronic Bronchitis and Emphysema?

A
  • Chronic Bronchitis : 50% - 60%

- Emphysema : 35% - 45%

22
Q

What is the ABG of a patient with Chronic Bronchitis and Emphysema?

A

Chronic Bronchitis :

  • PaO2 = 45-60 mmHg
  • PaC02 = 50-60 mmHg

Emphysema :

  • PaO2 = 65-75 mmHg
  • PaCO2 = 35-40 mmHg
23
Q

What are the results of a spirometry test of a patient with Chronic Bronchitis and Emphysema?

A
  1. Decreased FEV1 (< 80% of predicted amount)
  2. Decreased FVC
  3. FEV1/FVC < 70% of predicted amount
  4. No changes in FEV1 post bronchodilator
  5. Decreased PEFR
  6. Decreased V max
24
Q

What are the goals of management of COPD?

A
  1. Relieve symptoms
  2. Improve exercise tolerance
  3. Improve health status
  4. Prevents progression of the disease
  5. Prevent and treat complications
  6. Reduce mortality
25
Q

What kind of treatment is preferred in a Stable COPD patient?

A

Inhalational Treatment

26
Q

What is the 1st choice drug used in COPD?

A

L.A.M.A. (Long Acting Antimuscarinic Agent)

Ex. : Tiotropium

27
Q

What is the 2nd choice drug used in COPD?

A

L.A.B.A. (Long Acting Beta Agonists)

Ex. : Salmeterol, Formoterol

28
Q

What is the 3rd choice drug used in COPD?

A

ICS (Inhaled Corticosteroids)

Ex. : Beclomethasone, Budesonide, Fluticasone

29
Q

What are the drugs used in COPD for short term relieve?

A
  • S.A.B.A. (Short Acting Beta Agonists) - Salbutamol, Levosalbutamol, Terbutaline
  • S.A.M.A (Short Acting Antimuscarinic) - Ipratropium
30
Q

What are the advantages of Inhalational Therapy?

A

The drugs are delivered in aerosols/powders. They are directly delivered to the airways. 1st pass metabolism in the Liver is and unwanted systemic effects are minimized.

31
Q

State 4 types of delivery systems commonly used.

A
  1. Metered Dose Inhalers
  2. Dry Powder Inhalers
  3. Spacers
  4. Nebulisers
32
Q

How do you assess and grade the airflow limitation in a patient?

A

Airflow Limitation Assessment

GOLD 1 : FEV1 = more or equal to 80%
GOLD 2 : FEV1 = 50-79
GOLD 3 : FEV1 = 30-49
GOLD 4 : FEV1 = <30

33
Q

How do you prescribe drugs for COPD patients?

A
  1. Assess their Exacerbation History and Symptoms
  • Exacerbation History :
    0/1 (Admission not required) = 01A
    1 or more (Admission required) = 12A
  • Symptoms (mMRC) :
    0-1 = 01S
    >2 = 2S
  1. Categorize them based on the criteria above.
  • 01A + 01S = A
  • 01A + 2S = B
  • 12A + 01S = C
  • 12A + 2S = D
34
Q

What would you prescribe to a ‘Category A’ patient?

A

Bronchodilators

  1. SAMA - Ipratropium
  2. SABA - Salbutamol
35
Q

What would you prescribe to a ‘Category B’ patient?

A

Long Acting Bronchodilators

  1. LABA + LAMA
36
Q

What would you prescribe to a ‘Category C’ patient?

A
  1. LAMA
  2. LAMA + LABA
  3. LAMA + ICS (Budesonide, Fluticasone)
37
Q

What would you prescribe to a ‘Category D’ patient?

A

LAMA + LABA + ICS

  • Roflumilast (if FEV1 < 50%)
  • Macrolides (if smoker)
38
Q

How would treat a patient with pulm. exacerbations?

A
  1. Administer antibiotics
  2. Administer systemic steroids
  3. Provide mechanical ventilation, if required.

*Avoid high flow oxygen

CLINICAL MEDICINE (5 decks)

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