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CSI > Chronic Obstructive Pulmonary Disease > Flashcards

Chronic Obstructive Pulmonary Disease Flashcards

1
Q

What medication did he recently take for his chest infection?

A

Amoxicillin

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2
Q

What is his smoking history?

A

30 pack-year

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3
Q

What symptoms and signs does Mr Craven present with?

A

‘Catching his breath a bit over the last few months’
Finds climbing the stairs and running for more difficult
Slower pace when walking

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4
Q

What does the GP suggest?

A

Breathing test using spirometer

Set up meeting with stop smoking counsellor

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5
Q

What does the GP say is the best way to stop smoking?

A

Combination of medication and specialist support

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6
Q

What are the 4 main causes of breathlessness?

A

Lung conditions
Heart conditions
Anxiety
Being unfit

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7
Q

How can lung conditions cause breathlessness?

A

Cause airways to become inflamed and narrowed
Fill the airways with phlegm so it harder for air to move in and out of the lungs
Make the lungs stiff and less elastic so its harder for them to expand and fill with air

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8
Q

Give examples of lung conditions that can causes long-term breathlessness?

A 
COPD
Asthma 
Interstitial Lung disease (inc. pulmonary fibrosis)
Bronchiectasis
Industrial/Occupational e.g. asbestosis
Lung cancer
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9
Q

What lung conditions cause acute breathlessness?

A 
Asthma/COPD flare up
Pulmonary embolism 
Pneumonia
Tuberculosis
Pneumothorax
Collapsed lung
Build up of fluid in lung or lining of lungs
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10
Q

How can chronic breathlessness be caused by heart conditions?

A 
Problems with:
Rhythm 
Valves
Cardiac muscles 
Heart is unable to increase its pumping strength in response to exercise
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11
Q

When might heart failure due to breathlessness worsen?

A

Worse at night or when asleep

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12
Q

Which heart conditions can cause acute breathlessness?

A

Heart attack
Abnormal heart rhythm
(palpitations)

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13
Q

How can anxiety cause breathlessness?

A

Normal body response by your body to what you think is a stressful situation
Your body prepares for action
As you get more anxious you may start to breather faster and tense your breathing muscles

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14
Q

What is a panic attack?

A

When your body’s normal response is exaggerated
Rapid build up of physical responses
Body tries to take in more oxygen so heart beats faster and muscles tense

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15
Q

What are the symptoms of a panic attack?

A 
Have a pounding heart
Feel faint
Sweat
Feel sick
Have shaky limbs
Feel you're not connected to your body
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16
Q

Why might being unfit cause breathlessness?

A

Muscles get weaker

Weaker muscles need more oxygen to work

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17
Q

How can being an unhealthy weight make us feel breathless?

A

Underweight: Breathing muscles will be weaker
Overweight: More effort to breathe and move around
Having more weight in chest or abdomen restricts how much you lungs can move

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18
Q

What BMI value will mean you are more susceptible to breathlessness?

A

25

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19
Q

What can people who are severely overweight develop?

A

Obesity hypoventilation syndrome

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20
Q

Want is obesity hypoventilation syndrome?

A

Poor breathing leads to lower oxygen levels and high CO2 levels in their blood

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21
Q

What are the other reasons of chronic breathlessness?

A

Smoking
Conditions that affect how your muscles work
e.g. muscular dystrophy, MG and motor neurone disease
Postural conditions that alter the shape of your spine e.g. scoliosis and kyphosis
Anaemia
Kidney disease
Thyroid disease

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22
Q

What should someone experiencing breathlessness do when they go to see their doctor?

A

Think about how they’ll describe their breathlessness

Bring someone who can help

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23
Q

What is the MRC breathlessness scale?

A

Scale health professionals use to measure breathlessness

Shows what it stops you from doing

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24
Q

What does grade 1 on the MRC scale represent?

A

Not troubled by breathlessness except on strenuous exercise

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25
Q

What does grade 2 on the MRC scale represent?

A

Short pf breath when hurrying on the level or walking up a slight hill

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26
Q

What does grade 3 on the MRC scale represent?

A

Walks slower than most people on the level, stops after a mile or so, or stops after 15 minutes walking at own pace

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27
Q

What does grade 5 on the MRC scale represent?

A

Too breathless to leave the house, or breathless when undressing

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28
Q

What is important to tell your doctor?

A

what you used to be able to do that you can’t do any more
what people of your age around you do that you think you should be able to do
what your personal goals are for your day-to-day activity

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29
Q

What tests might a GP carry out?

A 
No. of breaths per minute
Listen to your chest
Feel how your chest moves as you breathe 
Heart rate and rhythm 
Blood pressure and temperature
Height, Weight, Waist and BMI
Examine head/neck and armpits for swollen lymph glands
Look at eyes, nails, skin and joints
Blood oxygen levels
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30
Q

What may a GP refer a patient with breathlessness for?

A 
Chest X-Ray
Spirometry
ECG
Echocardiogram
Blood tests
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31
Q

What could blood tests detect?

A

Anaemia
Allergies
Thyroid/ Liver/ Kidney/ Heart problems

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32
Q

What would you look for on chest radiography?

A

Signs of heart failure

Pulmonary pathology

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33
Q

What would you look for on a ECG?

A

Heart failure
Arrhythmia
Pulmonary embolism

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34
Q

What would you look for when performing a spirometry test?

A

Signs of obstructive airway disease

Restrictive pattern associated with interstitial lung disease

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35
Q

What would a U+E and a blood glucose test show?

A

Renal failure and diabetes as causes of metabolic acidosis and breathlessness

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36
Q

What could a thyroid function test detect?

A

Thyroid disease as a cause of breathlessness

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37
Q

How can you assess heart failure?

A

B-type natriuretic peptide test

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38
Q

What factors are characteristic of asthma?

A

A large response to bronchodilators

Significant diurnal or day-day variability of serial peak flow measurements

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39
Q

What should you do for patients with COPD?

A

arrange chest radiography to exclude other serious lung pathology (such as lung cancer) and check the full blood count to identify anaemia or polycythaemia

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40
Q

What is SOBOE?

A

Shortness of breath on exertion

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41
Q

What are the possible respiratory differential diagnosis for Mr Craven?

A 
Asthma
COPD
Pulmonary fibrosis
Lung cancer
Pulmonary embolism
Pneumothorax
Lower respiratory tract infection
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42
Q

What are the possible cardiovascular/systemic differential diagnosis for Mr Craven?

A 
Congestive heart failure
Pulmonary oedema
Valvular defects
Acute coronary syndrome
Anaemia
Renal or liver failure 
Deconditioning
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43
Q

What questions would you ask to hone this differential?

A 
Chest pain?
Does it wake you up at night?
Does it get worse whilst lying flat?
Any lifestyle changes? 
Occupation?
Cough?
44
Q

What examinations would you perform to hone this differential?

A 
Check for lung/breath sounds 
(Lamina or Turbulent flow/ Crackling)
Cyanosis 
Barrel chest: hyper-expanded 
Pitting Oedema
Tar staining on fingernails
Heart sounds: leaky valves/murmurs
45
Q

What happens if the LHS of the heart isn’t functioning?

A

Pooling of blood/fluid in the lungs

46
Q

What happens if the RHS of the heart isn’t functioning?

A

Oedema in the legs

47
Q

What investigations would you carry out?

A

ECG
CXR
Spirometry
Blood tests

48
Q

What is FVC?

A

Forced vital capacity

Total volume of air expelled after inhalation

49
Q

What is FEV1?

A

Forced expiratory volume

Volume expelled after inhalation on 1 second

50
Q

Give examples of restrictive diseases

A 
Obesity 
TB
Scoliosis 
Neuromuscular weakness e.g. MG
Pulmonary fibrosis
51
Q

Give examples of obstructive diseases

A 
COPD
Asthma
Cystic fibrosis
Emphysema
Chronic Bronchitis
52
Q

What characterises a obstructive disease?

A

FEV1/FVC ratio of less that 0.7
Only expel less than 70% of your total volume in 1 second
Narrowing of airways

53
Q

What characterises a restrictive disease?

A

FEV1/FVC ratio higher or normal
FVC is lower by FEV1 the same
Something preventing your lungs from expanding fully

54
Q

What does COPD encompass?

A

Bronchitis

Emphysema

55
Q

What is the pathophysiology for Bronchitis?

A 
Inflammation and irritation 
Caused by smoking, asbestos etc. 
Hypertrophy of goblet cells
Increased mucus production 
Airway narrowing- increase blood flow, inflammatory mediators therefore wall thickens, lumen narrows 
Inhibits action of cilia
56
Q

What is the pathophysiology of emphysema?

A 
Damage to the walls of the alveoli
via elastase enzyme 
Reduces surface area for gas exchange 
Alveoli unable to recoil 
Air becomes trapped
57
Q

How does emphysema cause an obstructive disorder?

A

Less pressure and force keeping the airways open and they collapse in on themselves
Damage of the alveoli (surrounding tissue) causes this

58
Q

What abnormalities are seen on Mr. Craven’s X-ray?

A

Diaphragm is flattened
Smaller/Elongated heart
Barrel chest

59
Q

What are the signs of hyperinflation?

A

More the 7 anterior ribs visible at the mid-clavicular line
Flattening of the diaphragm
Heart may appear small and narrow
Bullae

60
Q

What causes hyperinflation?

A

Emphysema

61
Q

What are bullae?

A

When alveoli become a singular unit
Very big
Delicate outer wall
Can burst causing pneumothorax

Air filled spaces with thin walls, bordered only by remnants of alveolar septae
Shown as black areas on CXR

62
Q

What are steps that someone can take to stop smoking?

A

Nicotine replacement therapy e.g. patches, sprays, lozenges etc.
Smoking cessation therapist
Education about the harmful affects of smoking

63
Q

Why is nutrition important in COPD?

A

Boost immune system to prevent infection
Deal with practical issues e.g unable to eat while coughing
If malnourished, muscles are weaker affecting breathing
If obese, difficulty in expanding the chest

64
Q

How can improvements in nutrition be made?

A

Referral to dietician

Patient resources

65
Q

Why is important to keep well in the cold?

A

Increased risk of infection during the winter
Flu jab
Pneumoccocal vaccine
Infective exacerbate of COPD- rescue packs with steroids and antibiotics

66
Q

What are the three main categories of inhaled medications?

A

Inhaled corticosteroids
Anti-cholinergics
Beta agonists

67
Q

What is the mechanism of beta agonists?

A

Bronchodilation

Sympathetic nervous system stimulation

68
Q

What is the mechanism of anticholinergics?

A

Prevent bronchoconstirciton

Act against parasympathetic nervous system

69
Q

What is the mechanism of corticosteroids?

A

Reduce inflammation

70
Q

What is the main cause of preventable illness and premature death in the UK?

A

Smoking tobacco

71
Q

What can smoking cessation be associated with?

A

Temporary withdrawal symptoms

Caused by nicotine dependence

72
Q

What are symptoms of withdrawal?

A 
Nicotine cravings
Irritability
Depression
Restlessness
Poor concentration 
Light-headedness
Sleep disturbances
Increased appetite
73
Q

What is recommended to be the most effective approach?

A

Abrupt quiting

Combination of drug treatment and behavioural support

74
Q

Where should patients wishing to stop smoking be referred to?

A

local NHS stop smoking serviced

if the decline to attend a suitable healthcare professional

75
Q

What is NRT?

A

Nicotine replacement therapy

76
Q

What drugs are used in NRT?

A

Varenicline (Champix)

Bupropion hydrochloride

77
Q

What is taken in to consideration when choosing which drug?

A 
Smoker's adherence 
Preference 
Previous experience of smoking-cessation aids
Contra-indications 
Side effects
Pregnancy/ Breastfeeding
78
Q

What are he most effective options?

A

Varenicline OR
combination of long-acting NRT (transdermal patch) and short-acting NRT (lozenges, gum, sublingual tablets, inhalator, nasal spray and oral spray)

79
Q

What can be used if the most effective treatments options are not appropriate?

A

Bupropion hydrochloride

Single therapy NRT

80
Q

How are patches applied?

A

Transdermal
16 hours
Removed overnight
If they experience cravings on waking a 24 hour patch can be used

81
Q

When are short acting nicotine preparations used?

A

Whenever the urge to smoke occurs or to prevent cravings

82
Q

How may smokers who are unwillingly to stop use NRT?

A

‘Harm reduction approach’
Smoking reduction
Temporary abstinence
Improves chance of stopping smoking in the long term

83
Q

How do e-cigarettes work?

A

Deliver nicotine without the toxins found in tobacco smoke

Cannot be prescribed

84
Q

How does smoking affect pregnancy?

A

Harmful effects of exposure to second-hand smoke for both mother and baby
Ongoing support should be offered during and following pregnancy.
NRT should only be used in pregnant females if non-drug treatment options have failed

85
Q

What may cause an increase in dose in other drugs?

A

Polycyclic aromatic hydrocarbons found in tobacco smoke increase the metabolism of some drugs

86
Q

What forms of NRT therapy are available?

A 
Skin patches
Chewing gum
Inhalators
Tablets, oral strips and lozenges 
Nasal and mouth spray
87
Q

How long does NRT treatment last?

A

Typically 8-12 weeks
Gradually reduce the dose
Eventually stop

88
Q

Who can use NRTs?

A

Over 12s
Under 18s shouldn’t use lozenges without medical advice
Pregnant women
Breastfeeding women

89
Q

What are the possible side effects of NRTs?

A 
Skin irritation
Irritation of nose, throat or eyes
Difficulty sleeping 
Upset stomach
Dizziness
Headaches
90
Q

How is Varenicline taken?

A

1-2 tablets a day

A week or two before starting to quit

91
Q

Who cannot take Varenicline?

A

Children under 18
Pregnant/Breastfeeding women
People with severe kidney problems

92
Q

What are the side effects of Varenicline?

A 
feeling and being sick
difficulty sleeping (insomnia), sometimes with vivid dreams
dry mouth
constipation or diarrhoea
headaches
drowsiness
dizziness
93
Q

How is bupropion taken?

A

1-2 tablets a day
1-2 weeks before quitting
7-9 weeks with treatment
Cannot be taken by people with epilepsy/bipolar disorder/ eating disorders

94
Q

What are the side effects of bupropion?

A 
dry mouth 
difficulty sleeping (insomnia)
headaches
feeling and being sick
constipation
difficulty concentrating
dizziness
95
Q

What are the fundamentals of COPD care?

A 
Offer treatment and support
Offer pneumococcal and flu vaccines
Offer pulmonary rehab 
Co-develop a self-management plan
Optimise treatment for co-morbidities
96
Q

When are inhaled therapies needed?

A

Relieve breathlessness
Exercise limitation
Other therapies were not successful

97
Q

What is a pMDI?

A

Pressurised metered dose inhaler

98
Q

What is a spacer?

A

Can be used to reduce side effects and alleviate symptoms

Lesser dose

99
Q

How long should you wait between puffs?

A

30 seconds - 1 minute

100
Q

How should you use a Respimat (SMI) inhaler?

A 
Prime the inhaler 
Twist until clicks and open cap 
Hold horizontally 
Sit or stand up straight 
Tilt chin up
Breathe out gently and slowly 
Make tight seal with lips 
Breathe in steadily and press grey button 
Hold press for at least 10 seconds
101
Q

How many times do you need to prime your inhaler?

A

If not used in 1 week: Once

If not used in 3 weeks: 3 times

102
Q

What should you do if you have used an inhaler that contains steroids?

A

Rinse your mouth with water

103
Q

What is a turbohaler inhaler?

A

Dry powder device

DPI

104
Q

How do you prime a turbohaler?

A

Twist off cover and hold upright

Turn base one way and then the other until a click is heard

105
Q

How do you use a turbohaler?

A 
Hold upright 
Sit or stand up straight 
Tilt chin up
Breathe out gently and slowly 
Make tight seal with lips 
Breathe in steadily and press grey button 
Hold press for at least 10 seconds
106
Q

How do you use a turbohaler?

A 
Hold upright 
Sit or stand up straight 
Tilt chin up
Breathe out gently and slowly 
Make tight seal with lips 
Breathe in quickly and press grey button 
Hold press for at least 10 seconds

CSI (17 decks)

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