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MD2 Intersession 2 > Chronic Obstructive Pulmonary Disease (COPD) > Flashcards

Chronic Obstructive Pulmonary Disease (COPD) Flashcards

1
Q

What is COPD?

A

Group of disorders characterised by airway inflammation and airflow limitation > not fully reversible
Progressive
Abnormal inflammatory response to noxious stimuli

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2
Q

What is the pathogenesis of COPD?

A 
Noxious agent > inflammation >
- Small airway disease >
   - Airway inflammation
   - Airway remodelling
- Parenchymal destruction >
   - Loss of alveolar attachments
   - Loss of elastic recoil
Airflow limitation
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3
Q

What are the mediators of inflammation in the airways, lung parenchyma, and pulmonary vessels?

A 
Neutrophils
Macrophages
CD8 T cells
Proteinase-antiproteinase imbalance
Oxidative stress
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4
Q

What are the changes in lung parenchyma in COPD?

A

Alveolar wall destruction
Loss of elasticity
Destruction of pulmonary capillary bed
Increased inflammatory cells

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5
Q

What is the mechanism of emphysema?

A

Proteinase-antiproteinase imbalance > digestion of elastin and other structural proteins in alveolar wall

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6
Q

What inflammatory cells are prominent in emphysema?

A

Macrophages

T cells

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7
Q

What are the different patterns of emphysema?

A

Centriacinar = radiates from terminal bronchiole
Panacinar = more generalised
Bullae

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8
Q

What are the risk factors for COPD?

A 
Primary = cigarette smoking
Occupational exposure to irritants
Alpha1- antitrypsin deficiency
Bronchial hyper-responsiveness
Passive smoking
Air pollution
- Indoor
- Outdoor
Recurrent respiratory tract infections in childhood
Genetic predisposition
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9
Q

In whom should you consider COPD in?

A 
Any past/current smoker
Chronic cough
Productive cough
Dyspnoea
History of exposure to other risk factors
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10
Q

How is COPD diagnosed?

A 
Spirometry best measure of airflow obstruction
FER = forced expiratory ratio
FER = FEV1/FVC pr FEV1/VC
- Using larger of FVC or VC
FER <0.7 > airflow obstruction
- Cut-off varies with age
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11
Q

Compare the course of COPD and asthma

A 
COPD = progressive
Asthma = variable
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12
Q

Compare the time of onset of symptoms in COPD and asthma

A 
COPD = late onset of symptoms
Asthma = generally young age of onset
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13
Q

Compare the association of smoking with COPD and asthma

A 
COPD = usually moderately heavy smoking history
Asthma = no association with smoking history
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14
Q

Compare airflow limitation in COPD and asthma

A 
COPD = not completely reversible
Asthma = Substantially/completely reversible
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15
Q

Compare the inflammatory mediators in COPD and asthma

A 
COPD = neutrophils
Asthma = largely eosinophils
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16
Q

Compare the airways involved in COPD and asthma

A 
COPD = mostly peripheral airways
- Fibrosis > obliterative bronchiolitis
Asthma = all airways
- Doesn't involve lung parenchyma
- No fibrosis
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17
Q

Compare mucus hyper-secretion in COPD and asthma

A 
COPD = more prominent
Asthma = less prominent
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18
Q

What are the goals of therapy in COPD?

A

Control symptoms
Improve lung function and health status
Prevent exacerbations
Reduce hospital admissions

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19
Q

What is the management of COPD?

A

COPD-X plan

  • C = confirm diagnosis and assess severity
  • O = optimise lung function
  • P = prevent deterioration
  • D = develop support network and self-management plan
  • X = exacerbation - manage appropriately
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20
Q

Does ceasing smoking in COPD have any effect?

A

Yes, slows decline in lung function

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21
Q

What is Ventolin and Airomir?

A

Salbutamol = SABA

22
Q

What is Bricanyl?

A

Terbutaline = SABA

23
Q

What is Serevent?

A

Salmeterol = LABA

24
Q

What is Oxis and Foradile?

A

Eformoterol = LABA

25
Q

What is Onbreez?

A

Indacaterol = LABA

26
Q

What is the use of short-acting beta-agonists in COPD?

A

PRN

27
Q

What is the use of long-acting beta-agonists in COPD?

A

Regular use >

  • Fewer symptoms
  • More exercise
  • Better QOL
28
Q

What are the side effects of beta agonists?

A

Tremor

Tachycardia

29
Q

What is Spiriva?

A

Tiotropium = LAMA

30
Q

What is Atrovent?

A

Ipratropium = LAMA

31
Q

What is Seretide?

A

Fluticasone = steroid + salmeterol = LABA

32
Q

What is Symbicort?

A

Budesonide = steroid + formoterol = LABA

33
Q

What does combination therapy (inhaled steroid + LABA) do in moderate to severe COPD?

A

Reduce exacerbations
Improve QOL
Improve FEV1

34
Q

What does pulmonary rehabilitation do?

A

Improves exercise capacity and QOL

May reduce exacerbations and hospitalisations

35
Q

What are the two main components of pulmonary rehabilitation?

A

Improve fitness

Education

36
Q

What are the vaccines given in COPD as part of management?

A

Influenza vaccine
- Yearly
Pneumococcal vaccine
- Twice 5 years apart

37
Q

What is the role of home oxygen therapy in COPD?

A

Improves mortality

No effect on symptoms

38
Q

How is home oxygen therapy administered?

A

2-4 L/min via nasal prongs for >16 hours/day if

  • PO2 on air at rest <55 mmHg OR
  • PO2 <60 mmHg with evidence of hypoxic damage
  • No cigarette smoking for 3 months
39
Q

What are some examples of hypoxic damage in COPD?

A

Cor pulmonale
Pulmonary HTN
Polycythaemia

40
Q

What are some other treatments in COPD?

A 
Chronic ABs
- Generally not recommended
Mucolytics
- Small benefit
- May help some patients
Non-invasive ventilation
- Unproven for chronic use
- Only used in some patients
Lung volume reduction surgery
- Improves symptoms
- Improves QOL
- No clear survival advantage
- Consider lung transplant
41
Q

What is recommended therapy at stage I (mild) COPD?

A

Active reduction of risk factors
Vaccinations
Add short-acting bronchodilators

42
Q

What is recommended therapy at stage II (moderate) COPD?

A

Add regular treatment with 1+ long-acting bronchodilators PRN
Add rehabilitation

43
Q

What is recommended therapy at stage III (severe) COPD?

A

Add inhaled glucocorticosteroids if repeated exacerbations

44
Q

What is recommended therapy at stage IV (very severe) COPD?

A

Add long-term oxygen if chronic respiratory failure

Consider surgical treatments

45
Q

What is an exacerbation of COPD?

A

Change in patient’s baseline dyspnoea and/or sputum
Beyond day-to-day variations
Acute onset

46
Q

What are some causes of acute exacerbations of COPD?

A 
Respiratory infections
Heart failure
Arrhythmia
Systemic infection
Anaemia
Anxiety
Anything increasing metabolic rate
47
Q

What are the complications of exacerbations of COPD?

A

Decline in QOL
More rapid loss of lung function
Mortality

48
Q

What is the Anthonisen criteria for COPD exacerbations?

A

Increased dyspnoea
Increased sputum production
Sputum becoming discoloured

49
Q

What is the management for exacerbations of COPD?

A

ABs to cover Strep and Gram negatives useful if all 3 Anthonisen criteria present
CXR looking for pneumonia
Cover atypical bacteria if pneumonia present
Supplemental O2
- Aim to keep SpO2 >90% and/or PaO2 >60 mmHg

50
Q

How can a high dose of O2 in COPD with chronic hypercapnia cause a further rise in pCO2?

A

Reduced ventilatory drive
High PO2 in parts of lung overcoming hypoxic vasoconstriction > worsening V/Q mismatch
Haldane effect + O2 displacing CO2 from Hb

51
Q

What are other therapies in exacerbations of COPD?

A 
Bronchodilators
Oral corticosteroids
ABs if evidence of infection
Physical activity to prevent deconditioning
Non-invasive ventilation
52
Q

How do you prevent exacerbations of COPD?

A 
Smoking cessation
Vaccinations
Tiotropium
LABAs
Theophylline
Inhaled corticosteroids
Inhaled corticosteroids + LABA
Pulmonary rehab
Mucolytics

MD2 Intersession 2 (1 decks)

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