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3: MED1 Y3 - Respiratory [18] > [2] COPD NO DRUGS > Flashcards

[2] COPD NO DRUGS Flashcards

1
Q

What is COPD?

A

A common, progressive disorder characterised by airflow obstruction, which is not fully reversible and does not change markedly over several months.

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2
Q

What does the umbrella term of COPD encompass?

A

Emphysema and chronic bronchitis, of which patients can have features of either or both

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3
Q

What is the pathological process in emphysema?

A

Destruction of terminal bronchioles and distal airspaces, as well as supporting tissue surrounding the small airways

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4
Q

What does the destruction of terminal bronchioles and distal airspaces in emphysema lead to?

A

The loss of alveolar surface area, and therefore impairment of gas exchange

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5
Q

How does the process of destruction of the terminal bronchiole and distal airspaces in emphysema often progress?

A

To the development of large redundant airspaces within the lung, called bullae.

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6
Q

What is the result of the destruction of supporting tissue surrounding the small airways in emphysema?

A

It causes the small airways to close/collapse during expiration when the pressure outside the airway rises

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7
Q

What does the collapse of small airways during expiration in emphysema result in?

A

Airflow obstruction, particularly affecting the small airways

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8
Q

What does loss of elastic tissue in emphysema lead to?

A

Hyperinflation of the lungs

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9
Q

Why does loss of elastic tissue in the lungs in emphysema lead to hyperinflation of the lungs?

A

Because the lungs are unable to resist the natural tendency of the ribcage to expand outwards

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10
Q

How is emphysema defined histologically?

A

As enlarged airspaces distal to the terminal bronchioles, with destruction of the alveolar walls

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11
Q

On which imaging modality can emphysema often be visualised?

A

CT

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12
Q

What is chronic bronchitis?

A

Chronic mucus hypersecretion

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13
Q

What causes chronic mucus hypersecretion in chronic bronchitis?

A

Inflammation in the large airways, usually due to cigarette smoke, leading to proliferation of mucus producing cells in the respiratory epithelium

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14
Q

What is the clinical consequence of chronic bronchitis?

A

Chronic productive cough and frequent respiratory infections

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15
Q

How does chronic bronchitis result in airflow obstruction?

A

Remodelling and narrowing fo the airways

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16
Q

What is the clinical definition of chronic bronchitis?

A

Cough and sputum production on most days for 3 months of 2 successive years

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17
Q

What are the causes of COPD?

A
  • Smoking
  • Occupational exposure
  • Air pollution
  • Alpha-1 anti-trypsin deficiency
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18
Q

Describe the relationship between air pollution and COPD

A

Exposure to air pollution over a long period of time can affect how well the lungs work, and some research has suggested it could increase the risk of COPD, however at present the link isn’t conculsive, and research is continuing

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19
Q

What is alpha-1-antitrypsin deficiency (AATD)?

A

A rare, inherited condition which can cause lung and liver problems

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20
Q

What is the mechanism of disease of AATD?

A

Patients lack the protective enzyme inhibitor alpha-1-antitrypsin, which makes them more vulnerable to effects of inhaling smoke or other toxic materials like dust, fumes, or chemicals

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21
Q

How is diagnosis of AATD made?

A

Blood test, which measures the level of alpha-1 antitrypsin

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22
Q

How is AATD managed?

A

At present, there is no specific treatment, and so treatment is focused around treating the lung and liver conditions if they arise

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23
Q

What are the symptoms of COPD?

A
  • Cough and sputum production
  • Wheeze
  • Dyspnoea, that is progressive
  • Frequent chest infections
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24
Q

What are the investigations into COPD?

A
  • History and examination
  • Spirometry
  • Chest x-rays
  • Blood tests
  • Peak flow tests
  • Sputum sample
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25
Q

What history features would suggest a diagnosis of COPD rather than asthma?

A
  • Age of onset over 35 years
  • Smoking history
  • Chronic dyspnoea
  • Sputum production
  • Minimal diurnal or day-to-day FEV1 variation
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26
Q

What are the examination features of COPD?

A
  • Tachypnoea
  • Use of accessory muscles of respiration
  • Hyperinflation
  • Decreased cricosternal distance
  • Reduced expansion
  • Resonant or hyperresonant percussion note
  • Quiet breath sounds
  • Wheeze
  • Cyanosis
  • Cor pulmonae
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27
Q

What is cor pulmonale defined as?

A

An alteration in the structure and function of the right ventricle of the heart, caused by a primary disorder of the respiratory system

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28
Q

How fast is the onset of cor pulmonale?

A

Usually has a chronic and slowly progressing course, however acute onset and worsening can occur

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29
Q

What are the symptoms of cor pulmonale?

A
  • Fatigue
  • Tachypnoea
  • Exertional dyspnoea
  • Cough
  • Haemoptysis
  • Anginal chest pain that does not respond to nitrates
30
Q

What is the treatment of cor pulmonale?

A
  • Treatment of underlying condition
  • In more advanced cases, more aggressive treatments such as heart and lung transplants may be required
31
Q

What are the findings of spirometry in COPD?

A
  • FEV1 <80% predicted
  • FEV1/FVC ratio <70%
  • Increased total lung capacity
  • Increased residual volume
32
Q

What does the chest x-ray show in COPD?

A
  • Hyperinflation
  • Flat hemidiaphragms
  • Large central pulmonary arteries
  • Decreased peripheral vascular markings
  • Bullae
33
Q

What does a severity assessment have implications for in COPD?

A

Therapy and prognosis

34
Q

What does the BODE index consider?

A
  • Body mass index
  • Airflow obstruction
  • Dyspnoea
  • Exercise capacity
35
Q

How is the BODE index used clinically in COPD?

A

It helps predict outcome, and number and severity of exacerbations

36
Q

What stages did the Global Initiative for COPD (GOLD) categorise COPD into?

A

Mild, moderate, severe, and very severe, based on post-bronchodilator FEV1% predicted

37
Q

How is COPD managed?

A
  • Stopping smoking
  • Inhalers and medication
  • Pulmonary rehabilitation
  • Surgery or lung transplant
38
Q

What are the first-line treatments in COPD?

A

Short acting bronchodilator inhalers

39
Q

How do bronchodilators help relieve the symptoms of COPD?

A

They decrease the work of breathing by relaxing and widening the airways

40
Q

What types of short acting bronchodilators are used in COPD?

A
  • ß2 agonist inhalers, such as salbutamol and terbutaline
  • Antimuscarinic inhalers, such as ipratropium
41
Q

At what frequency should short-acting bronchodilator inhalers be used in COPD?

A

They should be used when a patient is feeling breathless, up to 4 times a day

42
Q

When will long-acting bronchodilators be recommended for COPD patients?

A

If they experience symptoms regularly throughout the day

43
Q

How long does each dose of long-acting bronchodilator last in COPD?

A

At least 12 hours

44
Q

What are the types of long acting bronchodialtors used in COPD?

A
  • ß2 agonist inhalers
  • Antimuscarinic inhalers
45
Q

Give three examples of long-acting ß2 agonist inhalers used in COPD?

A
  • Salmeterol
  • Formoterol
  • Indacaterol
46
Q

Give three examples of antimuscarinic inhalers used as long-acting bronchodilators in COPD

A
  • Tiotropium
  • Glycopronium
  • Acildinum
47
Q

When are corticosteroid inhalers recommended for use in COPD?

A

When patients still get breathless when taking long-acting inhalers, or have frequent flare ups

48
Q

How do corticosteroid inhalers act in COPD?

A

They reduce the amount of inflammation in the airways

49
Q

What medications are used in the treatment of COPD?

A
  • Theophylline
  • Mucolytic tablets or capsules
  • Steroid tablets
  • Antibiotics
50
Q

How often is theophylline taken?

A

Twice daily

51
Q

What is the effect of theophylline in COPD?

A

It relaxes and opens up the airways

52
Q

What monitoring is required with theophylline?

A

Regular monitoring of blood levels of the drug

53
Q

What are the possible side effects of theophylline?

A
  • Nausea and vomiting
  • Headaches
  • Insomnia
  • Palpitations
54
Q

When might mucolytic tablets and capsules be recommended in COPD?

A

When a patient has a persistent chesty cough with lots of thick phlegm

55
Q

How do mucolytic tablets and capsules work in COPD?

A

They make mucus in the throat thinner, and easier to cough up

56
Q

When are steroid tablets used in COPD?

A

When the patient has had a severe exacerbation of their COPD

57
Q

How do steroid tablets work in COPD?

A

They reduce inflammation in the airways

58
Q

How long are steroid tablets taken for in COPD?

A

A 7 to 14-day course is usually recommended

59
Q

Why are steroid tablets only recommended for use for 7-14 days in COPD?

A

Long-term use of steroids can cause side effects including weight gain, mood swings, and osteoporosis

60
Q

What is required when a patient needs to be prescribed a longer course of steroids in COPD?

A

Must be prescribed by a COPD specialist, with the lowest effective dose given, and the patient must be monitored closely for side effects

61
Q

What is pulmonary rehabilitation?

A

A specialised programme of exercise and education, aimed to improve exercise capacity, symptoms, self-confidence, and emotional well being.

62
Q

How often does a patient require pulmonary rehabilitation

A

2 or more group sessions a week, for at least 6 weeks

63
Q

What does a typical pulmonary rehabilitation programme include?

A

Physical exercise tailored to patients needs and ability, such as walking, cycling, and strength exercises, education about the condition for the patient and family, and psychological and emotional support

64
Q

When is long-term oxygen therapy advised in COPD?

A

When COPD results in hypoxia

65
Q

How is long-term oxygen therapy delivered in COPD?

A

Can be delivered at home, through nasal tubes or a mask

66
Q

How much of the day should long-term oxygen therapy be delivered for in COPD?

A

At least 16 hours a day

67
Q

Which patients does NICE recommend long-term oxygen therapy for?

A
  • Clinically stable non-smokers with a PaO2 of <7.3kPa (value stable on 2 occassions, at least 3 weeks apart)
  • If PaO2 is 7.3-8.0, and the patient has pulmonary hypertension, polycythaemia, peripheral oedema, or noctural hypoxia
  • Terminally ill patients
68
Q

Who is suitable for surgery in COPD?

A

Only a small number of people, who have severe symptoms that cannot be controlled with medications

69
Q

What are the surgical options in COPD?

A
  • Bullectomy
  • Lung volume reduction surgery
  • Lung transplant
70
Q

What is a bullectomy?

A

Surgery to remove bullae from the lungs, allowing increased efficiency and more comfortable breathing

71
Q

What is lung volume reduction surgery?

A

Removal of a badly damaged section of the lung to allow the healthier parts to work better, and make breathing more comfortable

72
Q

What are the indications for specialist referral in COPD?

A
  • Uncertain diagnosis
  • Suspected severe COPD
  • Rapid decline in FEV1
  • Onset of cor pulmonae
  • Bullous lung disease
  • Assessment for oral corticosteroids, nebuliser therapy, or long-term oxygen therapy
  • <10 years pack smoking, or COPD patient <40 years
  • Symptoms disproportionate to lung function tests
  • Frequent infections

3: MED1 Y3 - Respiratory [18] (15 decks)

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