chronic obstructive pulmonary disease Flashcards
1
Q
what is COPD? 2
A
- preventable and treatable disease characterised by persistent progressive airflow limitation (not fully reversible)
- enhanced chronic inflammatory response in the lungs to noxious gases/ particles
- rising prevalence due to ageing population
2
Q
how can airways narrow? 3
A
- large airway inflammation- chronic inflammation of the bronchi causing inflammation and changes to the mucocilliary escalator, often resulting in a chronic cough (chronic bronchitis)
- emphysema- airways collapse due to destruction of alveolar walls- may lead to bullae
- small airways- due to bronchoconstriction and inflammation; duration and severity are risk factors for development of airway remodelling and COPD
3
Q
what happens to the airways in COPD? 6
A
- chronic inflammation
- increased number of goblet cells
- mucus cell hyperplasia
- fibrosis
- narrowing and reduction in the number of small airways
- airways collapse due to alveolar wall destruction in emphysema
4
Q
what do symptoms we need to diagnose COPD? 3
A
- chronic bronchitis= chronic productive cough for three months in 2 successive years, exclude other causes of chronic cough
- emphysema (alveolar)= abnormal and permanent enlargement of the airspaces due to the destruction of the alveolar airspace walls- effect gas exchange
- small airways disease= wheeze
5
Q
what are the risk factors for COPD? 8
A
- cigarette smoke
- occupational dust and chemicals
- environmental tobacco smoke
- indoor and outdoor air pollution
- genes
- infections
- socio-economic status
- ageing populations
6
Q
describe smoking history and COPD? 4
A
- age started
- calculate pack year history (smoking 20 cigarettes per day for a whole year)
- times stopped and why the attempt to quit failed
- recreational drugs smoked (or other substances e.g. shisha)
7
Q
how do we make a COPD diagnosis? 3
A
- symptoms (exertion breathlessness, productive cough, wheeze)
- risk factors (10 packs year smoking history and age over 35)
- spirometry (FEV1/FCV<0.7)
8
Q
what are the physical signs of COPD? 8
A
- barrel-shaped chest
- hyper resonant percussion
- accessory muscles
- prolonged expiraltion
- pursed lip breathing
- tripod position
- low BMI
- nicotine staining
9
Q
what are the physiological effects of COPD? 4
A
- increased work of breathing
- reduced exercise tolerance
- impaired gas exchange- hypoxia, hypercapnia, raised pulmonary artery pressure, RV dilation
- loss of fat free mass
10
Q
how do you manage chronic COPD? 7
A
- stop smoking
- if symptomatic LABA/LAMA combined inhaler
- flu vaccination
- educate and empower
- treat exacerbations
- pulmonary rehabilitation
- think about the whole patient (bone, nutrition, metal health)
11
Q
what is pulmonary rehabilitation? 4
A
- 2x supervised sessions for 6 weeks
- supervised exercise
- education
- psychological support/ group work
12
Q
name some additional treatments for COPD? 4
A
- theophylline (oral phosphodiesterase inhibitor)
- azithromycin 3 x a week (anti-inflammatory antibiotic prophylaxis)
- lung volume reduction surgery (valves/bullectomy)
- lung transplantation
13
Q
what is an acute exacerbation of COPD? 4
A
- acute deterioration in symptoms requiring additional therapy
- mild (SABA)
- moderate (SABA + steroids + antibiotics)
- severe (hospital admission)
14
Q
describe the events of a severe COPD exacerbation? 7
A
- ED attendance due to progressive dyspnoea/ hypoxia or signs of infection or signs of right heart failure
- antibiotics if there are signs of infection (sputa results)
- oral steroids
- target saturations 88-92% (controlled oxygen)
- nebulisers (bronchodilate)
- consider diuretics
- nicotine replacement therapy/ refer for smoking cessation
15
Q
what happens if treatment for COPD fails? 3
A
- decompensated hypercapnic respiratory failure despite controlled oxygen and nebulised treatments –> non-invasive ventilation
- respiratory failure despite nebulised therapy and controlled oxygen and patient unable to tolerate NIV–> consider invasive mechanical ventilation
- respiratory failure on background of significant progressive decline over several months or years with no evidence of reversible event–> palliate
