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Year 3 - TCD > Case 10 - COPD > Flashcards

Case 10 - COPD Flashcards

1
Q

What is COPD?

A

Airway obstruction due to inflammation of the small airways

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2
Q

What 2 diseases is COPD made up of?

A
  • Chronic bronchitis

- Emphysema

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3
Q

What is chronic bronchitis?

What are the symptoms?

A
  • Inflammation of the bronchi
  • Cough, chest pain, headache, malaise
  • Productive cough at least 3 months each year for 2 consecutive years
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4
Q

What is emphysema?

A
  • Permanent dilation of the alveoli and lose elasticity
  • Difficulty exhaling
  • Structural changes of the alveoli
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5
Q

What are the exogenous causes of COPD?

A
  • Smoking/ passive smoking
  • Air pollution
  • Occupational exposure: coal miners
  • Biomass fuel: industrialised countries
  • Recurrent pulmonary infections + TB
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6
Q

What are the endogenous causes of COPD?

A
  • α1-antitrypsin deficiency
  • Antibody deficiency syndrome (IgA deficiency)
  • Matrix metalloproteinases
  • TNF – α
  • Glutathione S transferase
  • Primary ciliary dyskinesia
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7
Q

How to classify COPD?

A
  • GOLD 1: Mild syx: ≥ 80%
  • GOLD 2: Moderate syx: 50–79%
  • GOLD 3: Severe syx: 30–49%
  • GOLD 4: V severe syx: < 30%
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8
Q

Below which FEV1/FVC ratio is there airflow limitation in patients?

A

<70%

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9
Q

What are the 2 types of emphysema?

A
  • Panlobular (panacinar)

- Centrilobular (centriacinar)

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10
Q

What are the signs and symptoms of COPD?

A
  • Chronic cough with expectoration (clear sputum) in the morning
  • Dyspnoea
  • Cyanosis
  • Barrel chest
  • Accessory muscle use
  • Peripheral oedema
  • Palpable liver edge
  • Reduced lung expansion
  • No diurnal variation
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11
Q

What is present on percussion of chest in COPD?

A
  • Hyper-resonant lungs: due to hyperinflation of lungs

- Reduced lung expansion

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12
Q

What is present on auscultation of chest in COPD?

A
  • Inspiratory wheeze
  • Corse crackle
  • Silent chest in advanced COPD
  • Decreased breath sounds advanced COPD
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13
Q

What is the normal oxygen saturations of COPD patients?

A

88%-92%

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14
Q

If FEV1 changes are <12% post bronchodilator, what does this mean?

A
  • Irreversible bronchoconstriction

- COPD

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15
Q

What are the signs of COPD on chest x-ray?

A
  • Flattened ribs
  • Flattening of diaphragm
  • Hyperlucency of lungs – appear blacker
  • Narrow cardiac diameter – lungs expanded so push into heart
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16
Q

What are the differentials for COPD?

A
  • Asthma
  • Bronchial carcinoma
  • Bronchiectasis
  • Congestive heart failure
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17
Q

What is bronchiectasis?

How to diagnose it?

A
  • Copious purulent sputum and mid inspiration coarse crackles
  • HR CT
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18
Q

How to conservatively manage COPD?

A
  • Smoking cessation
  • Nicotine replacement therapy
  • Nicotine receptor blockers (varenicline and bupropion)
  • Pneumococcal and influenza vaccination
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19
Q

What changes in breathing helps in COPD?

A

Pursed lip breathing - Breathe through nose and out slowly through lips
- Increases airway pressure

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20
Q

What differential would you consider in an older person presenting with asthma-like symptoms?

A
  • Asthma differentials in older people
  • Idiopathic pulmonary fibrosis
  • Churg-Strauss
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21
Q

What differential would you consider in a younger person presenting with COPD-like symptoms?

A
  • Alpha 1 antitrypsin deficiency
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22
Q

What investigations are conducted with COPD?

A
  • CXR
  • ABG: respiratory failure
  • FBC: polycythaemia
  • CT thorax: bullae, bronchial wall thickening
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23
Q

What is the treatment algorithm for COPD?

A
  • Start SABA/SAMA then use PRN
  • LABA
  • FEV1 > 50% = add LABA and LAMA
  • FEV1 < 50% = add LAMA, LABA, and ICS
  • Triple therapy: LABA + LAMA + ICS
24
Q

What are other treatment options for COPD patients?

A
  • Theophylline: aminophyillne
  • LTOT: PaO2 ≤ 55 mm Hg or SaO2 ≤ 88 % at rest
  • Mucolytics: Carbocisteine
25
Q

What surgical options are there for COPD patients?

A
  • Lung volume reduction
  • Lung transplant
  • Bullae removal
26
Q

What are the features of an acute exacerbation of COPD?

A
  • Increased SOB
  • Increased cough and wheeze
  • Increase in sputum/puerility (change in colourless sputum of COPD to more yellow/green)
  • Hypoxia and related confusion
27
Q

What investigations are done in COPD exacerbation?

A
  • ABG
  • CXR (excludes other diagnoses and provides evidence of infection)
  • FBC
  • U&E
  • CRP
  • ECG
28
Q

How to treat COPD exacerbation?

A
  • Salbutamol and ipratropium via nebuliser
  • Oxygen: Do not give 100% as it stops hypoxic drive
  • Steroids: IV hydrocortisone and oral prednisolone (continued for 1-2 weeks after)
  • Antibiotics (usually amoxicillin, doxycycline, or clarithromycin –
  • If nebulisers and steroids don’t help, add theophylline + NIV
29
Q

What is the pathophysiology of cor pulmonale?

A

Hypoxia -> pulmonary arterial vasoconstriction -> pulmonary hypertension -> RV hypertrophy -> RV failure

30
Q

Which lung volume increases in COPD?

A

Residual volume and total lung capacity

31
Q

What is the FEV1/FVC for restrictive disease?

What changes are there in residual volume and lung capacity?

A
  • > 70%

- Reduced residual volume and lower total lung capacity

32
Q

What is a pack year?

A

Number of cigarettes smoked a day/ 20 (in a pack) X number of years smoked for

33
Q

What is type 1 respiratory failure?

A

Decreased pO2

Normal pH

34
Q

What is type 2 respiratory failure (hypercapnia)?

A
  • Decreased pO2
  • Increased pCO2 >7 kPa
  • Lower pH
35
Q

What are the clinical features of hypercapnia?

A
  • Dilated pupils
  • Bounding pulse
  • Hand flap
  • Myoclonus
  • Confusion
  • Drowsiness
  • Coma
36
Q

What are the names of salbutamol inhalers?

A

Ventolin, airomir, salamol easi-breathe (blue inhalers)

37
Q

What is the name of terbutaline inhaler?

A

Bricanyl

38
Q

What is the name of salmeterol inhaler?

A

Serevent

39
Q

What is the name of formoterol inhaler?

A

Oxis

40
Q

What is the name of ipotropium bromide (SAMA) inhaler?

A

Atrovent

41
Q

What is the name of tiotropium (LAMA) inhaler?

A

Spiriva

42
Q

How is theophylline administered?

A

Modified release tablet

43
Q

What are the names of inhaled glucocorticoids?

A
  • Beclomethasone: becotide
  • Fluticasone: Flixotide
  • Budesonide: Pulmicort
44
Q

What is the MRC dyspnoea scale?

A
  • 0: only strenuous exercise
  • 1: Level ground/walking up a slight hill
  • 2: Walks slower than people of same age from dyspnoea, or has to stop for breath when walking at own pace on level ground
  • 3: Stops for breath after walking 100, or after a few minutes on level ground
  • 4: Too breathless to leave house
45
Q

What are the causes of

metabolic acidosis?

A 
- Increased acid production: 
= Diabetic ketoacidosis 
= Lactic acidosis 
= Aspirin overdose 
- Decreased acid excretion or loss of HCO3-:
= GI loss of HCO3- :diarrhoea, ileostomy, colostomy
= Renal tubular acidosis (retaining H+)
- Addisions disease (retaining H+)
46
Q

What are the causes of metabolic alkalosis?

A
  • Gastrointestinal loss of H+ ions: vomiting/diarrhoea
  • Renal loss of H+ ions – loop and thiazide diuretics / heart failure / nephrotic syndrome / cirrhosis / Conn’s syndrome
  • Iatrogenic – addition of alkali
47
Q

What are the causes of respiratory acidosis?

A
  • Pneumonia
  • Guillain Barre syndrome
  • Asthma
  • COPD
  • Latrogenic (excessive mechanical ventilation)
48
Q

What are the causes of respiratory alkalosis?

A
  • Anxiety – often referred to as a panic attack
  • Pain – causing an increased respiratory rate
  • Hypoxia – resulting in increased alveolar ventilation in an attempt to compensate
  • Pulmonary embolism
  • Pneumothorax
  • Latrogenic (excessive mechanical ventilation)
49
Q

What is respiratory alkalosis?

A

Hyperventilation leading to more CO2 being exhaled.

50
Q
  • What % of oxygen does a venturi mask deliver?

- What is it used in?

A
  • Delivers 24-60% oxygen

- COPD and when correct oxygen saturation are essential

51
Q
  • What % of oxygen does a non rebreathe mask deliver?
  • What is the flow rate?
  • How does it work?
  • When is it used?
  • What is the ideal saturation?
A
  • Delivers 85-90% oxygen
  • 15L flow rate
  • Bag on mask with valves stopping almost all rebreathing of expired air
  • Used for acutely unwell patients
  • 94-98%
52
Q
  • What is CPAP used for?
A

Acute pulmonary oedema, sleep apnoea, HF, pneumonia

53
Q
  • What are the indications for NIV/BiPAP?
A
  • pH <7.35, pCO2 >6.5 despite controlled oxygen therapy
  • Moderate to severe breathlessness with accessory muscle use
  • Respiratory rate >25/min
  • Used in exacerbations of COPD (without pneumonia) and ARDS
54
Q

What are the contraindications for NIV/BiPAP?

A
  • pH <7.25
  • Confusion
  • Recent upper GI surgery
  • Vomiting
  • Fixed airway obstruction
  • Life threatening hypoxemia
  • Haemodynamically unstable
55
Q
  • How long is LTOT used for?
  • What should the PaO2 be kept above?
  • What are the indications?
A
  • 15 hours a day
  • 8 kPa
  • Cyanosis
  • Polycythaemia
  • Peripheral oedema
  • Raised JVP
  • Oxygen saturations of 92% or less breathing air

Year 3 - TCD (17 decks)

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