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Respiratory Physiology > Clinical Features and Management of COPD > Flashcards

Clinical Features and Management of COPD Flashcards

1
Q

What causes airway obstruction in COPD?

A

Small airway narrowing

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2
Q

What endogenous substances and responses can make small airway narrowing worse?

A

Mucous and inflammation

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3
Q

What does worsening of airway narrowing resulting in?

A
  • Breathlessness on less exertion
  • Coughing
  • Wheeze
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4
Q

What is the gender predominance of COPD?

A
  • Male more than female
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5
Q

What is the relationship between income and COPD?

A

Lower income households have a higher prevalence

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6
Q

How does COPD impact NHS?

A
  • Increasing prevalence
  • GP hours
  • Hospital beds
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7
Q

What percentage of total COPD cases are linked to smoking?

A

85%

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8
Q

How does maternal smoking contribute to COPD?

A
  • Reduces FEV1

- Increases chances of IRDS

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9
Q

What occupations are associated with COPD?

A
  • Mining
  • Tunnel working
  • Construction
  • Farming
  • Any occupation involving exposure to dust
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10
Q

What is the function of a1 antitrypsin?

A

Neutralise enzymes released by neutrophils

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11
Q

What is the normal genotype for functioning a1 antitrypsin?

A

FiMM

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12
Q

What is the abnormal genotype for a1 antitrypsin?

A

PiZZ

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13
Q

How many years do you have to smoke a pack a day to typically have smoking related COPD?

A

20 years

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14
Q

What conditions are involved in the differential diagnosis of COPD?

A
  • Asthma
  • Lung cancer
  • Left ventricular failure
  • Fibrosing alveolitis
  • Bronchiectasis
  • TB
  • PE
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15
Q

How should a diagnosis of COPD be done?

A
  • Eliminate all other possible diagnoses first
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16
Q

What symptom differs asthma from COPD?

A
  • Asthma is a variable obstruction
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17
Q

What systemic symptoms may a patient with COPD present with?

A
  • Cachexia

- Peripheral Oedema

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18
Q

What other conditions should be considered if haemoptysis occurs?

A
  • Lung cancer
  • TB
  • Bronchiectasis
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19
Q

What does peripheral oedema suggest?

A
  • Cor pulmonale
  • Severe disease
  • Resp failure
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20
Q

With an adult with COPD, what might show in their childhood medical history?

A

Childhood asthma

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21
Q

What heart condition commonly shows in the PMH of a person with COPD?

A

Ischaemic heart disease

22
Q

What is important when taking a drug history of someone with suspected COPD?

A
  • Any inhalers

- Previous medications which may effect breathing

23
Q

What are the clinical SIGNS of typical COPD?

A
  • Breathlessness
  • Pursed lip breathing
  • Accessory breathing
  • Cyanosis
  • Flapping tremor
24
Q

Investigations needed before COPD diagnosis?

A
  • Spirometry
  • Full pulmonary function test
  • Lung volumes
  • CO gas transfer
  • Reversibility of obstruction from bronchodilators and oral corticosteroids
25
After initial investigations rule out asthma, what other investigations could be done?
- Chest x ray - Blood gases - FBC - ECG - Sputum
26
If FEV1 is normal what does it indicate with regards to COPD?
It rules it out
27
What spirometry results would indicate COPD?
FEV1/FVC ratio less than 70%
28
What chronic obstructive condition are you looking for when doing a pulmonary full functionality test?
Emphysema
29
What can be seen from doing spirometry?
Fixed airflow obstruction
30
What should happen to a patient with COPD in response to bronchodilators?
Minimal to no help
31
What should happen to a patient with COPD in response to oral corticosteroids?
Minimal to no help
32
If a suspected COPD sufferer responds to bronchodilators/oral corticosteroids what is probably going to be the diagnosis?
Asthma
33
What may be seen on a chest X ray of a COPD sufferer?
- Hyperinflated lungs - Flattened diaphragm - Bulla
34
What do chest x rays help diagnose if it isn't COPD?
- Cancer - Interstitial disease - Left ventricle failure
35
What does a decreased PaO2 and normal PaCO2 indicate?
Type 1 respiratory failure
36
What does a decreased PaO2 and increased PaCO2 indicate?
Type 2 respiratory failure
37
What is the condition called that means a high level of RBC's and will be shown by a FBC?
Polycytheamia
38
What might be found on a sputum test (MC&S)?
- Streptococcus pneumoniae - Haemophilus Influenzae - Moraxella Catarrhalis
39
What CONDITIONS can cause an acute exacerbation of COPD symptoms?
- Viral/bacterial infection - Pneumothorax - Trauma
40
How should acute exacerbations of COPD be managed?
- B2 bronchodilators - O2 - Oral corticosteroids - Antibiotics - Diuretics - Resp. stimulant
41
What is smoking cessation?
Quitting smoking
42
What is the aim of smoking cessation?
Prevention of progression of disease
43
What NHS management methods are there for COPD?
- Inhalers - Vaccines - Rehabilitation - Long term oxygen therapy
44
What lifestyle management methods are available?
- Smoking cessation | - Nutritional changes
45
What inhaled therapy options are there to relieve symptoms?
- Short and long acting bronchodilators | - High dose corticosteroids
46
2 examples of short acting bronchodilators?
- Salbutamol | - Ipratropium
47
2 examples of long acting bronchodilators
- Umeclidinium (long acting anti-muscarinic agent) | - Salmeterol (long acting B2 agonist)
48
2 examples of high dose inhaled corticosteroids?
- Relvar | - Fostair MDI
49
When is long term oxygen used?
- PaO2 <7.3kPa | - Normal PaO2 but with polycythaemia, sleep apnea, peripheral oedema or pulmonary hypertension
50
When should hospital admission of AECOPD be considered?
- Tachypnoea - Low sats - Hypotension
51
What steroid treatment is standard for AECOPD?
Prednisolone 40mg per day for a week
52
How should AECOPD patients on the ward be monitored?
- Try get sats to 92% - Nebulised bronchodilators - Corticosteroids - Antibiotics

Respiratory Physiology (16 decks)

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