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csi (phase 1b) > case 10 - breathlessness > Flashcards

case 10 - breathlessness Flashcards

1
Q

which lung diseases does COPD include?

A

emphysema and chronic bronchitis

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2
Q

what is emphysema?

A

damage to the air sacs (alveoli) in the lungs

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3
Q

what is chronic bronchitis?

A

long-term inflammation of the bronchi/airways

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4
Q

how does COPD develop?

A

develops gradually over many years such that patients often do not realise they have it
(no noticeable symptoms until late 40s/50s)

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5
Q

which lifestyle factor is most commonly linked to an increased risk of developing COPD?

A

long-term exposure to harmful substances such as cigarette smoke (most commonly)

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6
Q

at what age is COPD most likely to develop?

A

develops gradually but no noticeable symptoms until the age late 40/50

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7
Q

what are the most common symptoms of COPD?

A

increased breathlessness - during exercise or at night

a persistent chesty cough with phlegm

frequent chest infections

persistent wheezing

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8
Q

how do symptoms of COPD progress over time?

A

gradually get progressively worse over time

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9
Q

what is a COPD flare-up/exacerbation?

A

short periods of time where symptoms of COPD suddenly worsen

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10
Q

how common are flare-ups and when do they occur?

A

quite common, most occur during the winter

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11
Q

what are some less common symptoms of COPD?

A

weight loss
tiredness
swollen ankles from build-up of fluid (oedema)
chest pain/coughing up blood (could be sign of something else)

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12
Q

what are the risk factors for COPD?

A

smoking (even passive smoking)
fumes and dust at work (occupational causes)
air pollution
genetics

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13
Q

how is smoking a risk factor for COPD?

A

around 9 in 10 COPD cases are due to smoking

= the carcinogens can damage the lining of the airways and alveoli and increase COPD risk

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14
Q

how are fumes and dust at work a risk factor for COPD?

A

the fumes and dust contain chemicals that can damage the airways/alveoli and increase COPD risk (e.g. cadmium, grain, silica and welding fumes, isocyanates)

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15
Q

how is air pollution a risk factor for COPD?

A

inconclusive link

some evidence suggests that the chemicals in the air can damage the lungs and increase the risk of COPD

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16
Q

how are genetics a risk factor for COPD?

A

people who have a close relative with the condition OR people who have alpha-1 antitrypsin deficiency
= increases risk of COPD

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17
Q

what is alpha-1 antitrypsin?

A

a protein produced by the liver that protects the lungs from being damaged

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18
Q

why is alpha-1 antitrypsin deficiency a problem?

A

without alpha-1 antitrypsin, the lungs are more prone to damage

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19
Q

what tests can a GP do to diagnose COPD?

A 
physical examination
patient history
spirometry
chest x-ray
blood tests
ECG
echocardiogram
peak flow test
blood oxygen
phlegm sample
CT scan
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20
Q

what is spirometry?

A

a series of breathing tests a patient must do to help diagnose and monitor lung conditions

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21
Q

how is spirometry carried out?

A

use a bronchodilator to widen airways

breathe into a spirometer

two measurements made: the volume of air you can breathe out in one second AND the total volume of air you can breathe out

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22
Q

which two measurements are made in spirometry?

A

the total volume of air that is breathed out and the volume of air breather out in one second

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23
Q

why is a chest x-ray done to diagnose COPD?

A

to look for problems in the lungs that are characteristic of COPD

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24
Q

why are blood tests done to diagnose COPD?

A

to see if the symptoms have an alternative cause, besides COPD such as anaemia (low iron), polycythaemia (high concentration of erythrocytes) or alpha-1 antitrypsin deficiency

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25
Q

why are peak flow tests done to diagnose COPD?

A

measures how fast you blow air out of your lung = to rule out asthma

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26
Q

why is a phlegm sample done to diagnose COPD?

A

to check for any chest infections

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27
Q

how is COPD treated?

A

no cure but treatment slows progression of disease

stopping smoking
inhalers and tablets
pulmonary rehabilitation
surgery/lung transplant

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28
Q

why is smoking cessation effective treatment for COPD?

A

cigarette smoke causes damage to the airways/alveoli in COPD in the first place

to prevent further worsening/exacerbation of the symptoms, smoking must stop

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29
Q

why are inhalers and tablets effective treatment for COPD?

A

enable bronchodilation to ease breathlessness

30
Q

what is pulmonary rehabilitation?

A

pulmonary rehabilitation is a specialised programme of exercise and education which improves the amount of exercise you can do before you go out of breath

31
Q

what are the types of inhalers for COPD?

A

short-acting bronchodilators
long-acting bronchodilators
steroid inhalers

32
Q

how do short-acting bronchodilators work?

A

when you feel breathless, up to a maximum of 4 times a day

two types: beta-2 agonist (salbutamol, terbutaline) OR antimuscarinic (ipatropium)

33
Q

how do long-acting bronchodilators work?

A

each dose lasts 12 hours so only needs to be taken 1-2 times a day

two types: beta-2 agonist (salmeterol, fometerol, idacaterol) and antimuscarinic (tiotropium, glycopyronium, aclidinium)

34
Q

when should long-acting bronchodilators be used?

A

each dose lasts 12 hours so only needs to be taken 1-2 times a day

35
Q

what are steroid inhalers?

A

contain corticosteroid medicine which reduces inflammation of the airways

36
Q

when are steroid inhalers used?

A

if long-acting inhalers are not effective and patient still gets breathless and if patient has frequent flare-ups/exacerbations

37
Q

which tablets are most commonly prescribed for patients with COPD?

A

theophylline tablets
mucolytics
antibiotics
steroid tablets

38
Q

what are theophylline tablets?

A

bronchodilator but the mechanism of action is unclear BUT reduces inflammation of the airways and relaxes muscles lining airways

39
Q

what are theophylline tablets?

A

bronchodilator but the mechanism of action is unclear BUT reduces inflammation of the airways and relaxes muscles lining airways

40
Q

what are possible side effects of taking theophylline tablets?

A

palpitations

41
Q

what are possible side effects of taking theophylline tablets?

A

palpitations
insomnia
headaches
sickness

42
Q

what are mucolytics?

A

tablets that will make the phlegm thinner and easier to cough up = given only when the symptom of persistent, chesty cough is present

43
Q

give an example of a mucolytic

A

carbocisteine

44
Q

how often is carbocisteine taken?

A

tablets that can be taken 3-4 times a day

45
Q

what is an alternative mucolytic to carbocisteine that can be taken?

A

acetylcisteine (in powder form, mix with water)

46
Q

when are steroid tablets given?

A

a 5 day course of treatment for a particularly bad flare up

47
Q

why are steroid tablets not given for long-term use to treat COPD?

A

can cause unwanted side effects such as weight gain, mood swings and osteoporosis

48
Q

when are antibiotics prescribed in COPD?

A

if there are indications of a chest infection

49
Q

what is a key sign of a chest infection in a patient with COPD?

A

colour of the phelgm changes and phelgm becomes thicker (consistency)

50
Q

what does pulmonary rehabilitation involve?

A

physical exercise
education about your condition
dietary advice
psychological support

51
Q

how does nebulised medicine help a patient with COPD?

A

turns liquid medicine into a fine mist and so large dose of medicine can be taken in on go via a mask

52
Q

what is roflumilast?

A

tablet used to treat flare-ups that reduces inflammation in the airways

53
Q

when is roflumilast prescribed?

A

when a patient has has two severe exacerbations over the last 12 months, despite already using inhalers

54
Q

what are the side effects of roflumilast?

A

sickness
weight loss
headache

55
Q

what is long-term oxygen therapy?

A

when blood oxygen saturation is low, oxygen therapy can be given to normalise levels through nasal mask or tubes

taken for 16 hours a day - can be taken at home

56
Q

what is strictly not allowed when giving a patient long-term oxygen therapy?

A

smoking cigarettes as increased oxygen level is highly flammable = could cause explosion

57
Q

who qualifies for ambulatory oxygen therapy over long-term oxygen therapy?

A

patients whose oxygen saturations are normal during rest but fall during exercise

58
Q

what is non-invasive ventilation and when is it used?

A

mask attached to face which supports lungs and assists breathing, usually given to ease an exacerbation

59
Q

when is surgery an option to treat patients with COPD?

A

when their symptoms are not being controlled by medicine

60
Q

what are the three surgical options for patients with COPD?

A

bullectomy
lung volume reduction
lung transplant

61
Q

what is a bullectomy?

A

removal of an air space from the lung that makes breathing easier

62
Q

what is lung volume reduction surgery?

A

removal of a badly damaged piece of lung so only healthy lung remains

63
Q

what is a lung transplant?

A

removal of damaged lungs and replacement with healthy lungs from donor

64
Q

what is a comorbidity?

A

the simultaneous presence of two or more diseases in a patient

65
Q

what are some comorbidities for COPD?

A 
hypertension
diabetes mellitus
osteoporosis
anxiety
cardiac disease
hyperlipidaemia
66
Q

why is COPD particularly bad in patients during the winter?

A

collection of bacteria in the lung flare up when patient has a cold so particularly bad exacerbations in winter

67
Q

what is opacification on an x-ray?

A

when fluid/material builds up in the lung parenchyma and appears whiter/more opaque than the normal, healthy lung surroundings

68
Q

what is a pleural effusion?

A

buildup of excess fluid between the layers of the pleura

69
Q

is an infective exacerbation of COPD reversible?

A

most cases can return back to normal pre-exacerbation levels however a small proportion of cases cannot due to irreversible destruction of the airways

70
Q

what is an exacerbation?

A

acute change in symptoms of patient’s baseline - could be ue to infective or non-infective cause

71
Q

which test is essential for patients that present with shortness of breath?

A

chest x ray

csi (phase 1b) (8 decks)

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