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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

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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19
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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20
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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21
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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22
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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23
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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24
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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25
Q

why is a phlegm sample done to diagnose COPD?

A

to check for any chest infections

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26
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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27
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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28
Q

why are inhalers and tablets effective treatment for COPD?

A

enable bronchodilation to ease breathlessness

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29
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

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30
Q

what are the types of inhalers for COPD?

A

short-acting bronchodilators
long-acting bronchodilators
steroid inhalers

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31
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)
used for exacerbations

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32
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)

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33
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

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34
Q

what are steroid inhalers?

A

contain corticosteroid medicine which reduces inflammation of the airways

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35
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

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36
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

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37
Q

what are possible side effects of taking theophylline tablets?

A

palpitations
insomnia
headaches
sickness

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38
Q

when are steroid tablets given?

A

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

39
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

40
Q

when are antibiotics prescribed in COPD?

A

if there are indications of a chest infection e.g xray or green sputum

41
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)

42
Q

what does pulmonary rehabilitation involve?

A

physical exercise
education about your condition
dietary advice
psychological support

43
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

44
Q

what is roflumilast?

A

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

45
Q

when is roflumilast prescribed?

A

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

46
Q

what are the side effects of roflumilast?

A

sickness
weight loss
headache

47
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

48
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

49
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

50
Q

what is a lung transplant?

A

removal of damaged lungs and replacement with healthy lungs from donor

51
Q

what is a comorbidity?

A

the simultaneous presence of two or more diseases in a patient

52
Q

what are some comorbidities for COPD?

A 
hypertension
diabetes mellitus
osteoporosis
anxiety
cardiac disease
hyperlipidaemia
53
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

54
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

55
Q

what is a pleural effusion?

A

buildup of excess fluid between the layers of the pleura

56
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

57
Q

what is an exacerbation?

A

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

58
Q

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

A

chest x ray

59
Q

What is an ABG?

A

Arterial blood gas

60
Q

What are the effects of a COPD exacerbation?

A
  • decreased lung function
  • decreased physical activity
  • worsened mental health
  • decreased QoL
  • further COPD exacerbations
  • mortality
61
Q

What does this CXR show?

A

COPD

62
Q

What does this CXR show?

A

Infective exacerbation of COPD

63
Q

What does this CXR show?

A

Lung tumor

64
Q

What does this CXR show?

A

Pleural effusion

65
Q

What is low blood pH called?

A

Acidaemia

66
Q

What is high blood pH called?

A

Alkalaemia

67
Q

What can cause acidaemia?

A
  • respiratory acidosis (high PCO2)
  • metabolic acidosis (low HCO3)
68
Q

What can cause alkalaemia?

A
  • respiratory alkalosis (low PCO2)
  • metabolic alkalosis (high HCO3)
69
Q

What is hypoxia?

A

low blood oxygen

70
Q

What is hypercapnia?

A

high blood CO2

71
Q

What is type 1 respiratory failure?

A
  • hypoxia without hypercapnia
  • impaired oxygenation of the blood
  • PaO2 < 8kPa
72
Q

What can cause type 1 respiratory failure?

A

pulmonary oedema, pneumonia, COPD, asthma, acute respiratory distress syndrome, chronic pulmonary fibrosis, pneumothorax, pulmonary embolism, pulmonary hypertension.

73
Q

What is type 2 respiratory failure?

A
  • hypoxia with hypercapnia
  • impaired exertion of CO2 from the lungs
  • Pa CO2 >6.5 kPa
74
Q

What can cause type 2 respiratory failure?

A

commonly caused by COPD but may also be caused by chest-wall deformities, respiratory muscle weakness and Central nervous system depression

75
Q

How do kidneys compensate for respiratory acidosis caused by hypoventilation?

A
  • metabolic compensation
  • secretion of H+
  • reabsorption of HCO3
  • increase in plasma pH
76
Q

How do the lungs compensate for metabolic acidosis caused by renal failure?

A
  • respiratory compensation
  • hyperventilation
  • decrease in pCO2
  • increase in plasma pH
77
Q

What is the compensatory mechanism of respiratory acidosis?

A

metabolic alkalosis

78
Q

What is the compensatory mechanism of metabolic acidosis?

A

respiratory alkalosis

79
Q

What is the compensatory mechanism for respiratory alkalosis?

A

metabolic acidosis

80
Q

What is the compensatory mechanism for metabolic alkalosis?

A

respiratory acidosis

81
Q

Where does vasoconstriction occur in the lungs of someone with COPD and why?

A

In the tissue with hypoxia, diverts blood to healthy tissue

82
Q

How does vasoconstriction in the lungs lead to longterm problems?

A
  • increases resistance
  • increases pressure
  • leads to pulmonary hypertension
83
Q

What happens to the heart due to consistent pulmonary hypertension?

A
  • hypertrophy of the heart
  • right sided ventricular failure
84
Q

What is the consequence of right ventricular failure in COPD?

A

pressure will build up in the venous system

85
Q

What is a CPAP machine?

A
  • Continuous positive air pressure
  • Delivers a constant flow of air through the tubing and mask
  • Only helps with inhalation
  • Keeps your airways patent and make sure they don’t close
86
Q

What is a BiPAP machine?

A
  • Bi-level Positive Airway Pressure
  • Delivers differing air pressure depending on inspiration and expiration
  • During inspiration the pressure in the thorax is lower
  • During expiration, the pressure in the thorax is higher
  • Reduces the work of breathing by decreasing expiratory pressure –> allows CO2 to be expelled much easier
87
Q

What are the indications for BiPAP use?

A
  • COPD with respiratory acidosis (pH < 7.35)
  • type 2 respiratory failure
  • weaning from tracheal intubation
88
Q

What are the indications for CPAP use?

A
  • Hypoxia in the context of chest wall trauma despite adequate anaesthesia and high flow oxygen
  • Cardiogenic pulmonary oedema
  • Pneumonia: as an interim measure before invasive ventilation or as a ceiling of treatment
  • OSA – Obstructive Sleep Apnoea
89
Q
A
90
Q
A
91
Q

What signs indicate that antibiotics should be prescribed?

A
  • Becoming more breathless
  • Coughing more
  • change in sputum colour (brown, green or yellow) and/or consistency of phlegm
  • X-ray abnormality (white spots – infiltrates)
92
Q

How are antibiotics administered in hospital?

A

intravenously as reaches tissue at faster rate than oral

93
Q

Which antibiotics might be used to treat an infective exacerbation of COPD?

A

amoxicillin, erythromycin

csi (phase 1b) (8 decks)

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