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COPD * Flashcards

GREEN

1
Q

What is COPD

A

Irreversible airway obstruction
characterised with
-chronic bronchitis
-emphysema
-A1AT Deficiency

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2
Q

What is Chronic bronchitis (Blue bloater)

A

Hypertrophy and hyperplasia of the bronchi mucus glands
Inflammatory cells infiltrate bronchi= lumen narrowing
Results
-mucus hypersecretion
-Cilliary dysfunction
-Narrow lumen
-Increase infection risk with air trapping

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3
Q

Whta is emphysema (Pink puffer)

A

Airspace enlargement and alveolar wall damage due to elastin destruction

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4
Q

What are the symptoms of COPD

A

Productive Purulent cough
Dyspnoea and Wheeze
Peripheral oedema (Cor Pulmonale)
Blue Bloater vs Pink puffer

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5
Q

What are the signs of COPD

A 
Accessory muscle respiration
Tachypnoea
Hyperinflation
Cyanosis
Cor Pulmonale 
Quiet breathing
Hyper resonant percussion
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6
Q

What are the investigations done for COPD

A

Spirometry <0.7
*Bronchodilator <12% FEV1 Increase
Bloods (PCV Raised = Polycythemia)
DlCO (Raised in COPD)
ABG (Type 2 resp fail)
ECG (P/Cor Pulmonale)
CXRAY (Barrel chest and Bullae)

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7
Q

What is the spirometry staging for COPD

A 
Mild = FEV1>80
Moderate = FEV1 50-79
Severe = FEV1 30-49
Fatal = FEV1<30
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8
Q

What would an CXR for COPD show

A

Flat diaphragm and bullae

Flat hemidiaphragm

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9
Q

How do you manage acute COPD after smoking cessation and vaccines

A
  1. Bronchodilator and Oxygen (88-92%)
  2. Oral Prednisolone
  3. CPAP before intubation/ventilation
    Extra = Nebulisers (Salbutamol and Ipratropium)
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10
Q

How do you manage long term COPD with lifestyle change (1st line)

A

Stop smoking
Change diet
Flu vaccines
Pulmonary Rehab

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11
Q

How do you manage COPD in the long term

A
  1. SAB2A/SAMA
  2. ….+LAB2A and LAMA (Asthmatic symptoms)
  3. ….+LAB2A and ICS (No Asthmatic symptoms)
  4. SAB2A +LAB2A +LAMA +ICS
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12
Q

Why might a patient need long term oxygen (LTOT)

A 
<90 O2 Sats on room air
PaC02 <7.3kPa with
-Polycythemia
-Peripheral oedema
-Raised JVP
-Pulmonary HTN
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13
Q

When should a COPD patient be offered Lung volume reduction surgery

A

Upper lobe emphysema
FEV1 <20
PaCO2 <7.3
TICO >20

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14
Q

What is the gold standard investigation for COPD

A

Spirometry w/bronchodilator reversibility

CXR if there are signs of malignancy

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15
Q

What type of ventilation should be used for Tap 1 Respiratory fail

A

CPAP (Continuous)

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16
Q

When should BiPAP ventilation be used

A

Type 2 Respiratory fail despite optimum treatment for infection

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17
Q

How does cigarette cause COPD

A

Mucosal gland hypertrophy
Airways and bronchi walls fill with neutrophils = inflammation
Connective tissue breakdowns and causes emphysema

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18
Q

What are the causes of COPD

A

Cigarettes
Alpha 1 ATT
Air Pollution

19
Q

How do cigarettes cause alpha 1 AAT Deficiency

A

Alpha 1 AAT is responsible for lung protection but cigarettes inactivate this and cause proteolytic lung damage

20
Q

How does Chronic Bronchitis cause COPD

A

Mucus gland hypertrophy and hyperplasia = Chronic inflammation infiltrating bronchi/oles = Lumen narrowing
(Blue Bloater)

21
Q

How does Emphysema cause COPD

A

Elastin destruction in alveolar air sacs and bronchioles
Air trapped in Bullae distal to blockage (Less elastin to keep walls open in expiration)
(Pink Puffer)

22
Q

What are Bullae

A

Large air sacs due to air trapping

23
Q

What are the four types of emphysema

A

Centriacinar (Smokers COPD)
Panacinar (A1AT Deficiency)
Distal Acinar
Irregular

Panacinar (A1ATD)

24
Q

How can A1ATD cause COPD

A 
NORMAL = A1AT destroys neutrophil elastase so elastin layer of lung is intact
PATHOLOGICAL = Less Liver production of A1AT = More Neutrophil Elastase = Paracinar emphysema
25
Q

What is the typical presentation of COPD w/A1AT Deficiency as the cause

A

Young male w/ little/ no smoking w/ COPD

26
Q

Discuss Blue bloaters vs Pink Puffers

A 
BB = Chronic purulent cough, Dyspnoea, Cyanosis, Obesity
PP = Minimal cough, Pursed lips, Barrel chest, hyperresonant
27
Q

How can dyspnoea be graded

A

MRC 1-5
1= Strenuous exercise = Dyspnoea
5 = Everyday activity = Dyspnoea

28
Q

What organisms can exacerbate COPD

A

H Influenzae
S Pneumonia
Tx = Amoxicillin

29
Q

If a patient presents with Obstruction (FEV1:FVC <0.7) But has more than a 12% increase of FEV1 with Bronchodilator, what is the most likely diagnosis

A

Asthma

30
Q

What is the main complication of COPD

A

Cor Pulmonale
-RHF with increased portal hypertension

31
Q

How can causative organisms of COPD be treated

A

Amoxicillin

32
Q

What enzyme DEGRADES ELASTIN in A1AT Deficiency

A

Neutrophil elastase

33
Q

What does neutrophil elastase normally do

A

degrades elastin layer of lungs

34
Q

What is the initial investigation done for COPD

A

Pulmonary function test (NO)
FEV1:FVC <0.7 on spirometery

35
Q

What is a pink puffer presentation complication

A

Bullae rupture

36
Q

What is the Bernouli principle

A

Elastin keeps walls open at expiration

37
Q

What causes respiratory acidosis in COPD

A

Excess o2 by ventilation
Increase dead space
Increase V/Q Mismatch
Increase C02 Retention
Respiratory acidosis

38
Q

What two drugs can be given in acute COP Exacerbations

A

Salbutamol
Ipratropium Bromide

39
Q

A patient who has SOB w/ little activity is graded at what level COPD

A

MRC Grade 5

40
Q

Salbuterol is what type of drug

A

SAB2A

41
Q

Salmeterol is what type of drug

A

LAB2A

42
Q

Tiotropium is what type of drug

A

LAM3A

43
Q

In what two instances should 02 ventilation be offered in COPD long term

A

O2 <88% (55mmHg)
O2 <90% (60mmHg) w/ Heart fail

Resp (14 decks)

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