COPD Flashcards
What are the different grades of breathlessness?
0 - only on strenuous exercise
1 - when hurrying on the level or walking up a slight hill
2 - walks slower than others of same age and level. Need to stop when walking at own pace.
3 - after walking few minutes on level or about 100 yards
4 - too breathless to leave house, when dressing.
What are some respiratory causes of breathlessness?
Pulmonary embolism, pulmonary fibrosis, COPD, lower RTI, pneumonia, pneumothorax, lung cancer
What are some cardiovascular causes of breathlessness?
Dysrhythmias, valvular diseases, acute coronary syndrome, congestive heart failure
What are some other causes of breathlessness?
Liver failure, anxiety, anaemia, deconditioning, beta blockers, obesity, aspirin, renal failure
What are the three steps in history taking?
History, examination, investigations
What is the SOCRATES of history taking?
Site
Onset
Character
Radiation
Associated symptoms
Timing
Exacerbations
Severity
(ICE, family history, past medical history, medication history, lifestyle)
What are some examinations used for breathlessness?
Heart, lungs, pulse, BP, BMI
Spirometry/peak flow
What are some investigations for breathlessness?
Chest X-ray, blood test for anemia, underactive thyroid or heart failure
What is an obstructive lung disease?
More proximal problem (bronchi, bronchioles)
Cannot get air out
Bronchial asthma, COPD, bronchiectasis, bronchiolitis, cystic fibrosis, alpha-1-antitrypsin deficiency
What is a restrictive lung disease?
More distal problem (lung parynchema)
Cannot get air in
Extrinsic - neurological, respiratory center depression
Intrinsic - lung fibrosis
How is a spirometry test carried out?
- Height and weight measures
- Nose is clipped to encourage mouth breathing
- Blow into mouthpiece connected to spirometer 3 times
- Spirometer creates graph of lung function
What does FEV1/FVC ratio show?
Proportion of FVC expired in 1 second.
Normal is >0.7.
Obstructive is lower than 0.7.
What is peak flow rate?
The greatest rate of airflow achieved. Steepest gradient.
What are the FEV1/FVC stats for obstructive and restrictive lung diseases?
Restrictive - FEV1/FVC normal, FEV1 lower, FVC lower.
Obstructive - FEV1/FVC lower, FEV1 lower, FVC lower but not as low as FEV1.
What 2 conditions contribute to COPD?
Chronic bronchitis and emphysema.
Both triggered by an inflammatory stimulus.
What does the typical COPD patient present with?
- middle aged man with extensive history of smoking
- suffering from breathlessness and cough with green or brown sputum
What is chronic bronchitis?
- inflammation of bronchiole tubes
- resultant mucus build up causes air trapping and recurrent chest infections
- chronic if produces productive cough for at least 3 months per year for 2 years
Why is there so much mucus in bronchitis?
Exposure to irritants and chemicals causes hypertrophy and hyperplasia of bronchial mucinous glands (in main bronchi) and goblet cells (in bronchioles)
Also cilia shorter and less mobile so harder to move mucus.
What causes the air trapping?
Obstruction in bronchioles.
Summary of bronchitis?
- chronic inflammation
- increase in goblet cells
- mucus gland hypertrophy and hyper secretion
- airway narrowing
- persistent coughing with sputum
What causes a green sputum colour?
In chest infections, lots of neutrophils employed.
Neutrophils rich in myeloperoxidase which contains iron.
Iron turns green in mucus.
What is emphysema?
Inflammation damages alveolar / small airway walls.
Elastin breakdown causes air trapping and poor gas exchange.
What causes elastin breakdown?
Smoking causes lung inflammation, in which neutrophils are involved. Neutrophils release neutrophil elastase, which degrades elastin.
Weakens airway wall causing collapse, so air trapping.
Increases compliance. Lower surface area:volume ratio.
Summary of emphysema?
- destruction of airspace walls
- loss of elastic recoil
- enlargement of airspaces
- decreased surface area for exchange
- hyperinflation
What are signs of COPD on a chest X-ray?
- more than 7 anterior ribs
- flattening of diaphragm
- heart appears small and narrow
What are some non-medical treatments for COPD?
- smoking cessation strategies
- eating a diet with more fat, less carbohydrates
- avoiding lower respiratory tract infections
What does the sympathetic nervous system do to the lungs?
Adrenaline/noradrenaline binds to beta 2 receptors, relaxing smooth muscle and dilating airways.
What does the parasympathetic nervous system do to the lungs?
Acetylcholine binds to muscarinic 3 receptors, contracting smooth muscle and constricting airways.
How do bronchodilators work on the PNS and the SNS?
PNS - antagonise muscarinic receptors, relaxing smooth muscle and dilating airways.
- short acting (ipratroprium bromide) and long acting (tiotropium and glucopyronium) muscarinic antagonists
SNS - activate beta 2 receptors, relaxing smooth muscle and dilating airways.
- short acting beta agonists (salbutamol) or long acting (formeterol and salmeterol)
Drug suffixes (-ol vs -ium)
-ol - beta agonist
-ium - muscarinic antagonist
Rescue vs maintenance?
Rescue - short acting
Maintenance - long acting
What do corticosteroids do?
Anti-inflammatory medications.
