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Year One - Respiratory System > Chronic Obstructive Pulmonary Disease (COPD) > Flashcards

Chronic Obstructive Pulmonary Disease (COPD) Flashcards

1
Q

What is chronic obstructive pulmonary disease (COPD)?

A

It is defined as an irreversible condition in which there is a gradual deterioration of air flow through the lungs, due to damaged lung tissue

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2
Q

What is the COPD triad?

A

Emphysema

Chronic bronchitis

Small airway fibrosis

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3
Q

What is emphysema?

A

It is defined as a condition in which inner walls of the alveoli weaken and rupture, creating enlarged air spaces

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4
Q

What is chronic bronchitis?

A

It is defined as a cough with sputum production for at least three months in two consecutive years

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5
Q

What are the four risk factors for COPD?

A

Smoking

Middle Aged > 35 Years Old

Alpha-1 Antitrypsin (AAT) Deficiency

Air Pollution

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6
Q

What is the most common risk factor for COPD?

A

Smoking

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7
Q

How does smoking cause COPD?

A

It inactivates alpha-1 antitrypsin , which causes emphysema

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8
Q

What is the inheritance of AAT deficiency?

A

Autosomal dominant

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9
Q

What is AAT deficiency? Explain how it is a risk factor of COPD

A

AAT is a protease inhibitor, which functions to prevent neutrophil elastase from breaking down alveolar structures

Therefore, AAT deficiency results in increased destruction of alveolar structure - precipitating emphysema development

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10
Q

Does AAT deficiency result in early or late onset COPD?

A

Early onset < 45 yrs old

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11
Q

What other organ tends to be affected by AAT deficiency?

A

Liver, resulting in cirrhosis

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12
Q

What are the six clinical features of COPD?

A

Progressive Dyspnoea

Chronic Productive Cough

Wheeze

Recurrent LRTIs

Peripheral Oedema

Tachypnoea

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13
Q

Describe the sputum associated with COPD

A

Colourless

However, may be green during infection

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14
Q

Why is peripheral oedema a clinical feature of severe COPD?

A

In severe COPD, cor pulmonale (right sided heart failure) can develop which leads to peripheral oedema

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15
Q

Which clinical feature is used to differentiate between COPD and heart failure?

A

Heart failure = orthopnea

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16
Q

What scoring system can be used to assess the severity of dyspnoea?

A

Medical Research Council (MRC) Dyspnoea Scale

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17
Q

What scoring system can be used to assess the impact of COPD on a patients wellbeing and daily life?

A

COPD Assessment Test (CAT) Score

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18
Q

What six investigations are used to diagnose COPD?

A

Spirometry

Blood Tests

Arterial Blood Gas (ABG)

Sputum Culture

Chest X-Ray (CXR)

ECG Scan

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19
Q

What is spirometry?

A

It measures the volume and flow of air during exhalation and inhalation

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20
Q

What three metrics can be obtained with spirometry?

A

Forced Expiratory Volume 1 (FEV1)

Forced Vital Capacity (FVC)

FEV1 : FVC

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21
Q

What is FEV1?

A

It is defined as the volume that has been exhaled at the end of the first second of forced expiration

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22
Q

What is FVC?

A

It is defined as the volume that has been exhaled after a maximal expiration, following a full inspiration

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23
Q

What spirometry result indicates COPD? Why does this make sense?

A

FEV1 : FVC < 70%

COPD is an obstructive lung disease

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24
Q

What does a FEV1 : FVC < 70% result indicate?

A

This means that the overall lung capacity is not as bad as the patient’s ability to quickly blow air out of their lungs

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25
Q

How can we use spirometry to differentiate between COPD and asthma? Why does this make sense?

A

We test the reversibility of airflow obstruction

This is due to the fact that COPD results in irreversible airflow obstruction, however asthma is reversible

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26
Q

How can we use spirometry to test airflow obstruction reversibility?

A

We administer bronchodilators or corticosteroids

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27
Q

What post-bronchodilator spirometry test result indicates COPD?

A

FEV : FVC < 70%

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28
Q

What spirometry results indicates stage one (mild) COPD?

A

Predicted FEV1 > 80%

Post-Bronchodilator FEV:FVC < 0.7

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29
Q

What spirometry result indicates stage two (moderate) COPD?

A

Predicted FEV1 = 50% – 79%

Post-Bronchodilator FEV:FVC < 0.7

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30
Q

What spirometry result indicates stage three (severe) COPD?

A

Predicted FEV1 = 30% - 49%

Post-Bronchodilator FEV:FVC < 0.7

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31
Q

What spirometry result indicates stage four (very severe) COPD?

A

Predicted FEV1 = < 30%

Post-Bronchodilator FEV:FVC < 0.7

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32
Q

What two investigations are used to diagnose COPD?

A

Clinical presentation

Spirometry

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33
Q

What are the three clinical criteria for a diagnosis of COPD?

A

> 35 years old

The patient presents with COPD clinical features

The patient presents with a COPD risk factor

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34
Q

What spirometry results indicate a diagnosis of COPD?

A

Spirometry = FEV : FVC < 70%

Post-bronchodilator spirometry = FEV : FVC < 70%

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35
Q

What two blood tests indicate a diagnosis of COPD?

A

Decreased Serum Alpha-1 Antitrypsin Levels

Decreased Transfer Factor for Carbon Monoxide (TLCO) Levels

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36
Q

What blood test can be used to differentiate between COPD and asthma? How?

A

TLCO

In COPD, TLCO levels are decreased, whereas in asthma they are increased

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37
Q

What additional blood test is conducted in COPD patients? Why?

A

FBC

To identify the development of secondary polycythaemia complications

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38
Q

What three ABG results indicate a diagnosis of COPD? Why does this make sense?

A

PaCO2 > 6

Bicarbonate > 30

pH < 7.35

These are signs of CO2 retention and respiratory acidosis

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39
Q

In what two ways are sputum cultures used to diagnose COPD?

A

They are used to identify chronic infections, such as pseudomonas

It enables targeted antibiotic therapy during COPD exacerbations

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40
Q

What are the four signs of COPD on CXRs?

A

Hyperinflation

Flattened Diaphragm

Hyperlucent Lungs

Bullae

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41
Q

How do we identify hyperinflation on CXRs?

A

The appearance of > 6 anterior ribs in the mid-clavicular line

OR

The appearance of > 10 posterior ribs in the mid-clavicular line

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42
Q

What is a bulla on CXR?

A

It is defined as an air space in the lung measuring > 1 cm in diameter in the distended state

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43
Q

What is another way in which CXRs are used to diagnose COPD?

A

They can be used to exclude lung cancer

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44
Q

How are ECG scans used to diagnose COPD?

A

They are used to identify the development of cor pulmonale complications

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45
Q

What are the two signs of cor pulmonale on ECG scans?

A

Peaked P waves

Right axis deviation

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46
Q

In what four ways do we conservatively manage COPD?

A

Smoking Cessation

Pulmonary Rehabilitation

Annual Influenza Vaccination

One Off Pneumococcal Vaccination

47
Q

What is the most effective intervention to prevent progression of COPD disease?

A

Smoking cessation

48
Q

What is step one of COPD pharmacological management?

A

It involves administration of a short acting bronchodilator

49
Q

What are two subclassifications of short acting bronchodilators?

A

Short-Acting Beta2 Agonists (SABA)

OR

Short-Acting Muscarinic Antagonists (SAMA)

50
Q

Name two SABAs examples

A

Salbutamol

Terbutaline

51
Q

Name an example of SAMA

A

Ipratropium Bromide

52
Q

What do we need to determine if step one of COPD pharmacological management fails?

A

Whether the patient has asthmatic/steroid responsiveness features

53
Q

What are the four criteria used to determine whether an individual has asthmatic/steroid responsiveness features?

A

Previous Asthma/Atopic Disease

Increased Eosinophil Count

FEV1 Variation > 400ml

Diurnal PEF Variation > 20%

54
Q

What is step two of COPD pharmacological management (in individuals with no asthmatic/steroid responsiveness features)?

A

Combined Long Acting Bronchodilator

55
Q

What is contained within combined long acting bronchodilators?

A

Long-acting beta2 agonist (LABA)

Long-acting muscarinic antagonist (LAMA)

56
Q

Name three examples of combined long acting bronchodilators

A

Anoro ellipta

Ultibro breezhaler

DuaKlir genuair

57
Q

What is step two of COPD pharmacological management (in individuals with asthmatic/steroid responsiveness features)?

A

Combined LABA & ICS

58
Q

Name three examples of combined LABA & ICS

A

Fostair

Symbicort

Seretide

59
Q

In step two of COPD pharmacological management, what do we need to remember about step one?

A

All patients who were administered SAMA as their first line, need to be switched to SABA

60
Q

What is step three of COPD pharmacological management?

A

It involves administration of triple therapy combination inhalers

61
Q

What is contained in triple therapy combination inhalers?

A

LABA

LAMA

ICS

62
Q

Name two examples of triple therapy combination inhalers

A

Trimbo

Trelergy ellipta

63
Q

What three oral pharmacological options can be used to manage COPD?

A

Oral Theophylline

Oral Prophylactic Antibiotics

Oral Mucolytics

64
Q

When is oral theophylline considered as a management option for COPD?

A

It is a fourth line management option, which should only be considered after trials of short/long acting bronchodilators or in those who are unable to administer inhaled therapy

65
Q

What oral prophylactic antibody can be used to manage COPD?

A

Azithromycin

66
Q

What are the three criteria for oral prophylactic antibiotic administration in COPD patients?

A

Non-Smokers

Optimised Standard Treatment

Recurrent Exacerbations

67
Q

What oral mucolytic can be administered to manage COPD?

A

Carbocysteine

68
Q

When do we consider oral mucolytics to manage COPD?

A

In those with a chronic productive cough

69
Q

In which six circumstances do we conduct assessment for LTOT administration?

A

FEV1 < 30%

Cyanosis

Polycthaemia

Peripheral oedema

Raised JVP

O2 saturations < 92%

70
Q

How do we assess whether patients should be administered LTOT?

A

ABG on two occasions, at least three weeks apart in patients with stable COPD on optimal management

71
Q

What ABG result indicates the administration of LTOT?

A

In cases where patients have a pO2 < 7.3

OR

In cases where patients have a pO2 1.3 - 8, with one of the following complications; secondary polycythaemia, peripheral oedema, pulmonary hypertension

72
Q

When is LTOT contraindicated? Why?

A

Smokers

Due to a risk of explosion/burns

73
Q

What are the five complications of COPD?

A

Hypercapnic Respiratory Failure

Cor Pulmonale

Bronchiectasis

Secondary Polycythaemia

Osteoporosis

74
Q

What is cor pulmonale?

A

It is right-sided heart failure due to chronic pulmonary hypertension

75
Q

What type of pleural effusion is associated with cor pulmonale - exudate or transudate?

A

Transudate

76
Q

When does cor pulmonale tend to arise in COPD?

A

End stage COPD

77
Q

What complication of COPD is associated with increased TLCO levels?

A

Secondary polycythaemia

78
Q

What is a COPD exacerbation?

A

It is defined as an acute deterioration of clinical features

79
Q

What is the most common trigger of COPD exacerbations?

A

Respiratory tract infection

80
Q

What are the four common infective agents that trigger COPD exacerbations?

A

Haemophilus influenzae

Streptococcus pneumoniae

Moraxella catarrhalis

RSV

81
Q

What is the most common infective agent to trigger COPD exacerbations?

A

Haemophilus influenzae

82
Q

What five investigations are used to diagnose a COPD exacerbation?

A

Blood Tests

Arterial Blood Gas (ABG)

Sputum Culture

Chest X-Ray (CXR)

ECG Scan

83
Q

What are the three blood tests used to diagnose a COPD exacerbation?

A

Full Blood Count (Increased WCC Levels)

Blood Culture (Infective Agent)

Urea & Electrolytes (Deranged Results)

84
Q

What three ABG results indicate a diagnosis of COPD exacerbation? Why does this make sense?

A

PaCO2 > 6

Bicarbonate > 30

pH < 7.35

These are signs of CO2 retention and respiratory acidosis

85
Q

In what other way are ABGs used to diagnose a COPD exacerbation?

A

It is used to identify the development of respiratory failure complications

86
Q

What are the two signs of type one respiratory failure on ABG?

A

Normal pCO2 levels

Decreased pO2 levels

87
Q

How can we remember type one respiratory features on ABG?

A

Only ONE result is affected

88
Q

What are the two signs of type two respiratory failure on ABG?

A

Decreased pCO2 levels

Decreased pO2 levels

89
Q

How can we remember type two respiratory features on ABG?

A

TWO results are affected

90
Q

How are sputum cultures used to diagnose COPD exacerbations?

A

It can be used to identify infections and enable targeted antibiotic therapy

91
Q

How are CXRs used to diagnose COPD exacerbations?

A

They can be used to identify infections

92
Q

How are ECG scans used to diagnose COPD exacerbations?

A

They are used to identify cor pulmonale complications

93
Q

When is oxygen therapy used to manage COPD exacerbations?

A

When oxygen saturation levels are below 88%

94
Q

What oxygen mask is used to deliver oxygen to COPD patients?

A

Venturi mask

95
Q

What is a venturi mask?

A

They are masks used to deliver a specific percentage of oxygen

96
Q

What oxygen saturation level is aimed for in COPD CO2 retainers?

A

88% - 92%

97
Q

Why do we aim for lower oxygen saturation levels in COPD CO2 retainers?

A

CO2 retainers respiratory drive is dependent upon CO2 levels

Therefore if we administer these patients too much oxygen, there is decreased stimulation of their respiratory drive - leading to a decreased respiratory rate and increased retention of CO2

98
Q

How can we identify CO2 retainers?

A

ABG - normal bicarbonate levels but increased pCO2 levels

99
Q

What oxygen saturation level is aimed for in COPD non-CO2 retainers?

A

> 94%

100
Q

When is non-invasive ventilation indicated for management of COPD exacerbations?

A

Respiratory acidosis persists despite immediate maximum standard medical treatment

PaCO2 > 6

pH < 7.35, > 7.26

101
Q

What non-invasive ventilation is used to manage COPD exacerbations?

A

Bi-level positive airway pressure

102
Q

What are the three pharmacological management options for COPD exacerbations in a primary care setting?

A

Short-Acting Bronchodilators

Prednisolone

Antibiotics

103
Q

How do we review short acting bronchodilator administration during COPD exacerbations?

A

We administer them at an increased frequency

In some cases, individuals are administered a nebuliser

104
Q

What prednisolone dose is administered to treat COPD exacerbations?

A

30mg once daily for a course of 5 - 14 days

105
Q

What three antibiotics are administered to treat COPD exacerbations?

A

Amoxicillin

Clarithromycin

Doxycycline

106
Q

When do we consider antibiotic administration in COPD exacerbations?

A

When individuals present with purulent sputum or clincial signs of pneumonia

107
Q

What are the five pharmacological management options for COPD exacerbations in a secondary care setting?

A

Nebulised Bronchodilators

IV Bronchodilators

Steroids

Antibiotics

Analeptics

108
Q

What two nebulised bronchodilators are administered to manage COPD exacerbations? At what dose?

A

Salbutamol 5mg/4h

Ipratropium bromide 500mcg/6h

109
Q

What IV bronchodilator is administered to manage COPD exacerbations?

A

Aminophylline

110
Q

When do we administer IV bronchodilators to manage COPD exacerbations?

A

In severe cases that don’t respond to nebulised bronchodilators

111
Q

What is the function of analeptics?

A

To stimulate the CNS

112
Q

What analeptic is administered to manage COPD exacerbations?

A

Doxapram

113
Q

When do we administer analeptics to manage COPD exacerbations?

A

In severe cases that don’t respond to oxygen therapy

Year One - Respiratory System (14 decks)

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