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Heart, Lungs and Blood > COPD > Flashcards

COPD Flashcards

1
Q

What is COPD characterized by?

A

COPD is characterized by progressive airflow obstruction that is not fully reversible and does not change markedly over several months.

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2
Q

At what age does COPD increase?

A

COPD increases with age over 60 years.

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3
Q

How does smoking affect the decline of FEV1 in COPD?

A

Smoking accelerates the decline of FEV1 of about 30 ml/year after the age of 30.

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4
Q

what is the main cause of COPD

A

Cigarette smoking causes COPD in 90% of cases.

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5
Q

is the risk of COPD associated with the number of pack years

A

yes

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6
Q

Does cigar and pipe smoking increase the risk of COPD?

A

yes

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7
Q

Can passive smoking increase the risk of developing COPD?

A

yes

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8
Q

What percentage of smokers develop COPD?

A

Only 15-25% of smokers develop COPD.

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9
Q

What is another cause of COPD besides smoking?

A

Occupational exposure to dusts and coal mining, air pollution, and lower socioeconomic groups can also cause COPD.

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10
Q

How common is α-1 antitrypsin deficiency in cases of COPD?

A

α-1 antitrypsin deficiency is found in 1-2% of cases of COPD.

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11
Q

What is chronic bronchitis defined as?

A

Chronic bronchitis is defined as sputum production for at least 3 months/year for at least 2 consecutive years.

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12
Q

What is emphysema?

A

Emphysema is a condition in which the destruction of alveoli distal to terminal bronchiole results in loss of elastic supporting tissue and affects gas exchange.

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13
Q

What is the role of α-1 antitrypsin in the lungs?

A

In healthy lungs, α-1 antitrypsin protects the lung from neutrophil elastase and maintains a balance so that healthy lung tissue is not damaged.

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14
Q

How does cigarette smoking affect the lungs?

A

Cigarette smoking activates neutrophils in the lungs and proteases which can lead to damage to alveolar sacs and the development of emphysema.

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15
Q

What happens in emphysema?

A

In emphysema, much of the alveolar surface of the lung is destroyed, reducing its availability for gas exchange.

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16
Q

How does chronic bronchitis develop?

A

Chronic bronchitis develops from inflammation of the airways with fixed structural changes, such as an increase in goblet cells and hypertrophy of the goblet cells, which leads to the production of viscous mucus that is hard to clear.

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17
Q

How does recurrent respiratory tract infections affect lung function in patients with chronic bronchitis?

A

Recurrent respiratory tract infections can lead to further inflammation of the lungs and a reduction in lung function in patients with chronic bronchitis.

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18
Q

How does COPD affect the airways and the lungs?

A

COPD increases airway resistance and causes a loss of elastic recoil of the lungs, leading to airway collapse on expiration, air trapping, and hyperinflation. This increases the work of breathing and may cause accessory muscle use, pursed-lip breathing, and other breathing difficulties.

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19
Q

What are the end stage consequences of COPD?

A

In end-stage COPD, patients may develop right heart failure (Cor pulmonale) and pulmonary hypertension.

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20
Q

What should be suspected in individuals with symptoms of breathlessness and history of cigarette smoking?

A

A diagnosis of COPD should be suspected.

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21
Q

How is the diagnosis of COPD confirmed?

A

The diagnosis of COPD is confirmed by spirometry showing an FEV1/FVC ratio of less than 70% predicted post-administration of a short-acting bronchodilator.

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22
Q

What are the symptoms of COPD?

A

Breathlessness on exertion (dyspnoea), chronic productive cough, frequent lower respiratory tract infections, progressive weight loss, peripheral (ankle) oedema (end-stage COPD), and red flag symptoms such as haemoptysis, chest pain, night sweats.

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23
Q

What are the signs of COPD?

A

Tachypnoea, tremors (if over-using β-2 agonist inhaler), pursed-lip breathing, use of accessory muscles, barrel chest, hyperinflation, wheeze, signs of right heart failure (cor pulmonale), cyanosis, signs of CO2 retention, and development of type 2 respiratory failure.

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24
Q

What does spirometry show in COPD?

A

Spirometry shows obstruction with a reduced FEV1 and FEV1/FVC < 70%, and no reversibility to bronchodilator 20 minutes after 200 mcg inhaled salbutamol with the FEV1 increasing by at least 15% of baseline or by more than 200 ml.

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25
Q

What is the effect of COPD on lung function tests?

A

The effect of COPD on lung function tests includes an increase in TLC and RV due to air trapping, and a reduction in transfer factor/diffusing capacity (TLCO/DLCO).

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26
Q

What is the mMRC Dyspnoea Scale used for?

A

The mMRC Dyspnoea Scale is used for determining the extent of breathlessness in COPD patients.

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27
Q

What does the GLOBAL INITIATIVE for COPD (GOLD) define?

A

The GLOBAL INITIATIVE for COPD (GOLD) defines the severity of COPD based on Spirometry values and the FEV1/FVC ratio.

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28
Q

What does a CXR show in COPD patients?

A

A CXR in COPD patients shows hyperinflation, with flat diaphragms and increased anterior ribs.

29
Q

What type of imaging is used to show bullae in the lungs?

A

HRCT is used to show bullae in the upper lobes of the lungs

30
Q

What is Pulse Oximetry used for in COPD patients?

A

Pulse Oximetry is used to determine the oxygen saturation levels in COPD patients, which can drop to below 92% as the condition worsens.

31
Q

What is an Arterial Blood Gas (ABG) test used for in COPD patients?

A

An Arterial Blood Gas (ABG) test is used to determine the levels of oxygen, carbon dioxide, and acidity in COPD patients and to detect type 1 or type 2 respiratory failure.

32
Q

What type of cardiac investigations are performed if cor pulmonale is suspected?

A

If cor pulmonale (right heart failure secondary to lung disease) is suspected, an ECG and an Echocardiogram are performed to assess right ventricular function and pulmonary hypertension.

33
Q

how do you assess quality of life for COPD

A

There are validated questionnaires that assess overall function and quality of life for COPD patients.

34
Q

What are the characteristics of the progression of COPD?

A

he progression of COPD is characterized by a progressive decline in lung function, which is largely irreversible, and an increased risk of type 2 respiratory failure and cor pulmonale (right heart failure)

35
Q

What are the different types of management for COPD?

A

Management of COPD includes lifestyle advice, pharmacological management, surgical management, and non-pharmacological management.

36
Q

What is included in lifestyle advice for COPD management?

A

Lifestyle advice for COPD management includes smoking cessation, increased physical activity, and improved nutrition.

37
Q

What is included in pharmacological management of COPD?

A

Pharmacological management of COPD includes inhaled therapy, management of exacerbations, long-term oxygen therapy, non-invasive ventilation for type 2 respiratory failure, and other medications as needed.

38
Q

What is included in surgical management of COPD?

A

Surgical management of COPD includes lung volume reduction surgery and lung transplant.

39
Q

What is included in non-pharmacological management of COPD?

A

Non-pharmacological management of COPD includes pulmonary rehabilitation, counseling, and palliative care.

40
Q

What is combination inhaled therapy for COPD management?

A

Combination inhaled therapy for COPD management includes various combinations of inhaled corticosteroids, short-acting beta-agonists, long-acting beta-agonists, and long-acting muscarinic antagonists

41
Q

What is the role of methylxanthines in the management of COPD?

A

Methylxanthines, such as theophylline and aminophylline, play a role in the management of COPD.

42
Q

What is carbocisteine and what is its role in the management of COPD?

A

Carbocisteine is a mucolytic and plays a role in the management of COPD.

43
Q

What is Ipratropium bromide (Atrovent)?

A

Ipratropium bromide is a muscarinic antagonist (SAMA) that blocks M3 receptors in the smooth muscle of airways, leading to bronchodilation. It is used for daily use in COPD via inhaler or for acute exacerbation via nebulization.

44
Q

How does Tiotropium (LAMA) work?

A

Tiotropium causes bronchodilation, reduces bronchospasm, decreases mucus production, and has a prolonged duration of action (12-24 hours) due to its slow dissociation from muscarinic receptors. It is indicated for COPD and chronic asthma and is given via inhaler.

45
Q

What are the side effects of SAMAs and LAMAs?

A

SAMAs and LAMAs can cause anticholinergic side effects due to the inhibition of the parasympathetic nervous system. These can include dry mouth, blurred vision, closed-angle glaucoma, urinary retention, cardiac arrhythmias, taste disturbance, dizziness, and epistaxis. Systemic side effects are rare as little systemic absorption occurs.

46
Q

What are methylxanthines used for in COPD management?

A

Methylxanthines, such as theophylline and aminophylline, are additional bronchodilators used in the management of COPD. They are phosphodiesterase inhibitors and have a narrow therapeutic range. Blood level monitoring is required, and they can interact with many drugs due to their effect on the cytochrome P450 enzyme system.

47
Q

What is the purpose of antibiotic prescription for COPD and asthma exacerbations?

A

Antibiotic prescription is given for bacterial chest infections causing exacerbation of asthma or COPD.

48
Q

What antibiotics are given for COPD and asthma exacerbations?

A

Amoxicillin is given for Streptococcus pneumonia, macrolides (clarithromycin) and vancomycin for staphylococcus aureus (MRSA).

49
Q

What is the management of acute exacerbation of COPD?

A

Management of acute exacerbation of COPD includes nebulised salbutamol and ipratropium bromide, systemic steroids, controlled oxygen, IV aminophylline, antibiotics, and non-invasive ventilation for type 2 respiratory failure.

50
Q

What is the purpose of oxygen therapy for COPD?

A

Oxygen therapy is indicated for Type 1 respiratory failure to maintain the saturation between 94-98% and for Type 2 respiratory failure to maintain saturation between 88-92%. Oxygen is not usually indicated for breathlessness, but can be used for intractable breathlessness in palliative care.

51
Q

What are the guidelines for prescribing antibiotics for COPD and asthma exacerbations?

A

Guidelines include following local prescribing guidelines, checking sensitivity of organisms, asking the patient about allergies, being aware of contraindications, checking for drug interactions and serious side effects, referring to the British National Formulary, and speaking to a microbiologist.

52
Q

What is Long-term Oxygen Therapy (LTOT)?

A

LTOT is a treatment for chronic hypoxaemia, in which patients with a pO2 of less than 7.3 kPa receive long-term supplemental oxygen. Conditions that may require LTOT include COPD, pulmonary fibrosis, and pulmonary hypertension.

53
Q

What should be included in a discharge plan for patients with chronic respiratory conditions?

A

The discharge plan should include the following: smoking cessation, appropriate inhaled therapy (ICS/LABA/LAMA + salbutamol for symptoms), checking inhaler technique, oral theophylline, assessing need for LTOT, assessing need for home nebuliser, proper nutrition, referral for pulmonary rehabilitation, psychological support, influenza and pneumococcal vaccination, and palliative care.

54
Q

What improves survival for patients with chronic respiratory conditions?

A

Factors that improve survival for patients with chronic respiratory conditions include: smoking cessation, LTOT, non-invasive ventilation (BiPAP), lung volume reduction surgery, reducing the number of exacerbations (frequent exacerbators are defined as those with more than two exacerbations requiring oral corticosteroids and/or antibiotics or one hospital admission per year), and oral corticosteroids.

55
Q

What are some common differences between asthma and COPD?

A

Asthma:
Wheeze in childhood
Atopy
Family history of asthma
Day to day variation in symptoms
Diurnal variation in PEFR
Mild eosinophilia
Spirometry may be normal
Reversibility to B-2 agonist
Reversibility to steroid
COPD:
Onset of symptoms over 35 years old
Significant smoking history
Occupational exposure
Constant symptoms
Flat PEFR chart
No eosinophilia
Spirometry shows airflow obstruction
Little reversibility to B-2 agonist
Limited reversibility to steroid

56
Q

what are the predominant cells in asthma

A

eosinophils

57
Q

what are the predominant cells in COPD

A

neutrophils

58
Q

what is the spirometry in asthma

A

FEV1/FVC <70% but reversibility

59
Q

what is the spirometry in COPD

A

FEV1/FVC <70% but no reversibility

60
Q

what is the lung function like in asthma

A

^ TLC and ^ RV normal or ^TLCO and KCO

61
Q

what is the lung function like in COPD

A

^ TLC and ^ RV
vv TLCO and KCO

62
Q

What is Sleep Apnea?

A

Sleep Apnea is the cessation of breathing during sleep.

63
Q

What are the two types of Sleep Apnea?

A

The two types of Sleep Apnea are Obstructive Sleep Apnea (OSA) and Central Sleep Apnea (CSA).

64
Q

What is Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS)?

A

OSAHS is a common condition where there are recurrent episodes of upper airway collapse during sleep, leading to symptoms like snoring, apneic episodes and excessive daytime sleepiness.

65
Q

What are the risk factors for OSAHS?

A

Risk factors for OSAHS include obesity with BMI > 30, collar size > 17 inches, enlarged tonsils/adenoids, enlarged tongue, long uvula, nasal pathology, retrognathia or micrognathia, acromegaly, hypothyroidism, and Down’s syndrome.

66
Q

What are the symptoms of OSAHS?

A

Symptoms of OSAHS include snoring, apnoeas, restless/disturbed sleep, choking, morning headaches, unrefreshed feeling on waking, excessive daytime sleepiness, decreased cognition, increased risk of hypertension and cardiovascular diseases.

67
Q

How is OSAHS investigated?

A

With overnight oximetry, full polysomnography, and an Epworth Sleepiness Score.

68
Q

How is OSAHS managed?

A

With weight loss, surgery (tonsillectomy, adenoidectomy), mandibular advancement device for mild OSA, Continuous Positive Airway Pressure (CPAP) for moderate/severe OSA. It is important to inform the DVLA and not to drive until treatment is established.

69
Q

What are the red flag symptoms for OSAHS?

A

Symptoms such as haemoptysis, persistent unexplained fever, night sweats, weight loss, and stridor suggest a serious underlying condition, such as cancer.

Heart, Lungs and Blood (51 decks)

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