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2. Respiratory Medicine (Lectures) > COPD > Flashcards

COPD Flashcards

1
Q

What does COPD stand for?

A

Chronic obstructive pulmonary disease

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2
Q

What is COPD?

A

Chronic, slowly progressive disorder characterised by airflow obstruction that does not change markedly over several months

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3
Q

Which gender gets COPD?

A

Male

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4
Q

Causes of COPD

A

Smoking (85%)
Chronic asthma
Passive smoking
Maternal smoking
Air pollution
Occupation (15-20%)

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5
Q

Examples of occupations causing COPD

A

Coal mining
Hard rock mining
Tunnel working
Concrete manufacturing
Construction
Farming
Foundry working
Plastics
Textiles
Rubber
Leather

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6
Q

What does a1-antitrypsin do?

A

Neutralises enzymes released by neutrophils

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7
Q

Genotypes of a1-antitrypsin deficiency

A

Normal genotype - PiMM (86%)
Troublesome genotype PiZZ (10-20%)

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8
Q

What can happen in a1-antitrypsin deficiency?

A

Bad emphysema can develop very quickly as nothing to neutralise the neutrophils
People tend to develop COPD at younger age

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9
Q

What is the most important cause of COPD?

A

Smoking

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10
Q

What % of smokers develop significant COPD?

A

20%

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11
Q

When would COPD tend to develop in non smokers?

A

Asthma
a1-antitrypsin

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12
Q

What is 1 pack year?

A

1 pack a day for a year

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13
Q

How many pack years does it usually take to develop COPD?

A

20 pack years

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14
Q

What is COPD defined by?

A

Airflow obstruction

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15
Q

Pathology of COPD

A

Luminal obstruction due to small airway narrowing and can be worsened by inflammation and mucus, leading to progressive breathlessness on exertion, along with coughing and wheezing
Breakage of alveolar cell membranes

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16
Q

What is a prime feature of COPD?

A

Mucus secretion

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17
Q

What is chronic bronchitis?

A

Sputum produced every day for at least 2 years

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18
Q

What is ACOS?

A

Asthma/COPD overlap syndrome

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19
Q

What conditions overlap to make up COPD?

A

Chronic bronchitis
Emphysema

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20
Q

Type of airflow obstruction in asthma

A

Reversible

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21
Q

Type of airflow obstruction in COPD

A

Fixed airflow obstruction

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22
Q

Presentation of COPD

A

SOB
- gradual onset
- little variation
- progressively getting worse
Cough
- long history of ‘smokers cough’
- clear of mucoid sputum
Wheeze
- typically on exertion
Progressive difficulty in performing ADLs
Weight loss (severe disease,

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23
Q

Typical COPD patient

A

Patient >40+ years
Smoker / ex smoker
SOB on exertion
Cough

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24
Q

Differential diagnosis of COPD

A

Asthma
Lung cancer
LVF
Fibrosing alveolitis
Bronchiectasis
TB
Recurrent PE

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25
Q

If the patient has symptoms of COPD with haemoptysis, what conditions must be looked into?

A

Lung cancer
TB
Bronchiectasis

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26
Q

Examples of causes of peripheral oedema

A

Cor pulmonale
Severe disease
Respiratory failure

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27
Q

Signs of COPD

A

SOB walking into clinic, undressing
Pursed lips
Accessory muscles
Cyanosis
CO2 flap, tremor (B-agonists)
Effects of steroids
Hyperexpanded (barrel) chest
Decreased expansion
Less than 3 finger spaces between manubrium and larynx
Laryngeal descent
Paradoxical movement of ribs and abdomen
Decrease in cardiac dullness to percussion
Decreased breath sounds
Prolonged expiration with wheeze
Palpable liver
Cor pulmonale

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28
Q

Why does pursed lips help in COPD?

A

Generates a bit more of a positive pressure which causes the airways to open up a bit more

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29
Q

Signs of steroid use

A

Thin skin
Bruising
Cushingoid

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30
Q

Do crackles occur in COPD?

A

NO

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31
Q

Signs of cor pulmonale

A

Increased JVP
Hepatomegaly
Ascites
Oedema

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32
Q

What are acute exacerbations of COPD caused by?

A

Viral/bacterial infection

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33
Q

Causes of acute exacerbation of COPD

A

Viral/bacterial infection
Sedative drugs
Pneumothorax
Trauma

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34
Q

Symptoms of acute exacerbation of COPD

A

Increased cough
Increased sputum
Increased SOB
increased wheeze
Unable to sleep
Increased oedema, confusion, drowsiness

35
Q

Investigations for acute exacerbations of COPD

A

CXR
Blood gases
FBC
U and Es
Sputum culture

36
Q

What does spirometry rule out if the FEV1 is normal?

A

COPD

37
Q

What is a normal FEV1?

A

> 80% predicted

38
Q

What spirometry result would be abnormal?

A

FEV1 < 80% predicted with FEV1/FVC ratio < 70%

39
Q

What is emphysema?

A

Damaged alveoli and so reduced gas transfer

40
Q

In asthma, is the gas transfer affected?

A

No

41
Q

How is fixed airflow obstruction demonstrated by spirometry?

A

Minimal bronchodilator reversibility
- Baseline, 15 mins post neb 2.5-5mg salbutamol, baseline 30 mins post neb 2.5-5mg salbutamol + 500ug ipratropium
Minimal response to oral corticosteriods
- 30 - 40mg prednisolone daily for 2 weeks
- measure baseline and final FEV1

42
Q

What would a significant bronchodilator/steroid response suggest?

A

Asthma/asthmatic component

43
Q

What bronchodilator response would be consistent with COPD?

A

Insignificant bronchodilator / steroid response

44
Q

Investigations for COPD

A

Spirometry
Full pulmonary testing
- Lung volumes
- carbon monoxide gas transfer
CXR
ECG
Blood gases
FBC
ECG
Sputum sample

45
Q

What may be seen on a CXR in COPD?

A

Hyperinflated lung fields (>10 posterior ribs)
Flattened diaphragms
Lucent lung fields
Bullae

46
Q

Decreased PaO2 on blood gas indicates what?

A

Type 1 respiratory failure

47
Q

Decreased Pa02 and increased PaCO2 indicates what?

A

Type 2 respiratory failure

48
Q

What would be seen on a FBC in COPD?

A

Secondary polycythaemia (hct > 0.52)

49
Q

What may be seen on an ECG in COPD?

A

Right axis deviation
P pulmonale
T wave insertion

50
Q

Inflammation type in COPD

A

Neutrophilic

51
Q

How to prevent disease progression in COPD?

A

Smoking cessation

52
Q

How to relieve breathlessness in COPD?

A

Inhalers

53
Q

How to prevent exacerbations of COPD?

A

Inhalers
Vaccines
Pulmonary rehabilitation

54
Q

How to manage complications of COPD

A

Long term oxygen therapy

55
Q

Non pharmacological management of COPD

A

Smoking cessation
Vaccines (flu, pneumococcal)
Pulmonary rehabilitation
Nutritional assessment
Psychological support

56
Q

Inhaled therapy for COPD

A

Short acting bronchodilators
- SABA (Salbutamol)
- SAMA (ipratropium)
Long term bronchodilators
- LAMA
- LABA
High dose ICS and LABA
- relvar
- fostair

57
Q

As there is more symptoms/exacerbations - staging of T for COPD

A
  1. SABA
  2. LAMA or LABA
  3. Further bronchodilator (LAMA and LABA)
  4. Triple therapy (ICS, LAMA, LABA)
58
Q

What does LTOT stand for?

A

Long term oxygen therapy

59
Q

What Pa02 should LTOT be used at?

A

< 7.3 kPa
7.3 - 8 kPa if
- polycythaemia
- nocturnal hypoxia
- peripheral oedema
- Pulmonary HTN

60
Q

Presentation of COPD exacerbation

A

Increasing SOB
Cough
Sputum volume
Sputum purulence
Wheeze
Chest tightness

61
Q

Management of acute exacerbation of COPD

A

SABA
Steroids
- prednisolone 40mg per day for 5 - 7 days
Antibiotics (if evidence of infection)

62
Q

When should hospital admission be considered if unwell?

A

Tachypnoea
Low oxygen sats (<90-92%)
Hypotension etc

63
Q

Ward based management of acute exacerbation of COPD

A

Oxygen target sats 88 - 92%
Nebulised bronchodilators
Corticosteriods
Antibiotics

64
Q

How can evidence of bronchodilators be assessed/

A

Clinical
ABG

65
Q

What should be done in acute respiratory failure?

A

Non invasive ventilation (NIV)

66
Q

Management of COPD

A

Nebulised bronchodilator B2 and antimuscarinic
O2 oral / IV corticosteriods
Antibiotics
Diuretic
IV aminophylline
Respiratory stimulant
NIV

67
Q

An organism causing pneumoniae in a COPD patient is most likely to be what?

A

Haemophilus influenzae

68
Q

Treatment for COPD (steps)

A

1st line
- SABA or SAMA
Next step is determined to do with whether there is asthmatic features/responsiveness
No asthmatic features
2. Add LABA or LAMA. Also if already taking a SAMA, switch to a SABA
Asthmatic features / responsiveness
2. LABA + ICS
3. Triple therapy i.e. LAMA + LABA + ICS. If already taking a SAMA, switch to a SABA

69
Q

What NICE criteria would suggest that a patient has asthmatic features/responsiveness in COPD?

A

Any previous secure diagnosis of asthma or atopy
A higher eosinophil blood count
Substantial variation in FEV1 over time (at least 400ml)
Substantial diurnal variation in PEFR (at least 20%)

70
Q

What prophylaxis may be done in select patients with COPD?

A

Azithromycin

71
Q

Monitoring of azithromycin

A

LFTs
ECG to exclude QT prolongation

72
Q

Who with COPD should be considered to get mucolytics?

A

Chronic productive cough and continued if symptoms improve

73
Q

Treatment of cor pulmonale

A

Loop diuretic
Oxygen long term

74
Q

What vaccinations should a COPD patient get?

A

Annual flu
One off pneumococcal

75
Q

What pH does NIV show most benefit?

A

7.25 - 7.35

76
Q

What pH should invasive ventilation be carried out?

A

< 7.25

77
Q

What can large bullae in COPD mimic?

A

A pneumothorax

78
Q

What is the severity of COPD judged by?

A

FEV1

79
Q

1st line antibiotics for an infective exacerbation of COPD

A

Amoxicillin or clarithromycin or doxycycline

80
Q

In alpha-1-antitrypsin deficiency, where is empysema more prominent in the lungs and how does this compare to in COPD?

A

Lower lobes in A1ATD
Upper lobes in COPD

81
Q

1st line pharmacological management of COPD

A

SABA or SAMA

82
Q

What criteria should be used to determine if patients having an exacerbation of COPD should require antibiotics?

A

Those with purulent sputum or clinical signs of pneumonia

83
Q

From the NICE guidelines, it is recommended that patients who have had frequent exacerbations of their COPD should be given what?

A

A home supply of prednisolone and antibiotics

2. Respiratory Medicine (Lectures) (50 decks)

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