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Respiratory System > COPD > Flashcards

COPD Flashcards

1
Q

What is COPD?

A
  • a disease characterised by persistent expiration symptoms + airflow obstruction
  • due to airways (bronchitis) and/or alveolar (emphysema) abnormalities
  • caused by significant exposure to noxious particles or gas
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2
Q

What is COPD caused by?

A

Significant exposure to noxious particles or gases e.g. smoking, soot

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3
Q

Symptoms of COPD

A

Shortness of breath
Chronic productive cough
Chronic sputum production
Recurrrent lower respiratory tract infections

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4
Q

Risk factors for COPD

A
  • Smoking
  • Host factors e.g. genetics, congenital abnormalities | alpha 1 anti trypsin deficiency
  • Occupation
  • Indoor/outdoor pollution
  • Illicit drug use e.g. heroin
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5
Q

What causes airflow limitation in COPD?

A
  • Small airways disease: airway inflammation, airway fibrosis > increased airway resistance (+ loss of radial traction)
  • Parenchymal destruction: loss of alveolar attachments > decrease of elastic recoil
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6
Q

Signs of COPD

A
  • purse lip breathing
  • prolonged expiratory phase
  • hyperinflation or barrel shaped chest
  • visible use of accessory muscle
  • Tachypnoea
  • wheeze on auscultation
  • rales (crackles)
  • hypoxemia + hypercapnia
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7
Q

Signs of late COPD

A
  • flapping tremor (hypercapnia)
  • central cyanosis (hypoxia)
  • right sided heart failure signs e.g. distended neck veins, ankle oedema
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8
Q

What is needed to diagnose COPD?

A

Spirometry test

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9
Q

Investigations for COPD

A
  • spirometry
  • BMI
  • CXR + CT thorax to exclude other diagnosis
  • FBC for polycythemia due to chronic hypoxia, anaemia+ infection
  • sputum culture
  • ECG + echo to assess heart failure + cor pulmonale
  • serum alpha-1 antitrypsin
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10
Q

How can you differentiate between asthma and COPD using spirometry?

A
  • asthma is reversible so if you give bronchodilators (SABA - salbutamol) the FEV1:FVC will increase (by at least 12%)
  • COPD is irreversible so bronchodilators wont increase ratio
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11
Q

How much must the FEV1:FVC increase after the use of bronchodilators for the condition to be deemed reversible (asthma)?

A

At least 12%

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12
Q

What two main conditions is COPD used to describe?

A

Emphysema: damaged air sacs
Chronic bronchitis: inflammation + productive cough

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13
Q

What is emphysema?

A
  • condition in which destruction of the terminal bronchioles + distal air spaces occurs via the breakdown of elastin
  • permanent enlargement of air spaces (bullae)
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14
Q

What is chronic bronchitis?

A
  • condition where there is hypersecretion of mucus due to inflammation of large airways
  • ciliary dysfunction > issue with clearance
  • productive cough
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15
Q

What is used to grade dyspnoea?

A

MRC dyspnoea score

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16
Q

outline the MRC dyspnoea score

A
  • grade 1: breathlessness on strenuous exercise
  • grade 2: breathlessness on walking uphill
  • grade 3: breathlessness that slows them down walking on the flat
  • grade 4: breathlessness stops them from walking >100m on flat
  • grade 5: unable to leave the house due to breathlessness
17
Q

How can severity of COPD be graded?

A

using FEV1
- stage 1/mild: FEV1 >80% of predicted
- stage 2/moderate: FEV1 50-79%
- stage 3/severe: FEV1 30-49*
- stage 4/very severe: FEV1 <30%

18
Q

What is exacerbation of COPD?

A

Acute worsening of respiratory symptoms that result in addition therapy
At least one major symptom:
- dyspnoea
- sputum volume
- sputum purulence

And one minor symptom:
- wheezing
- cough
- fever

19
Q

management of COPD exacerbations

A
  • oxygen: aim for 94-98% or 88-92% if T2RF or evidence of hypercapnia
  • salbutamol + ipratropium nebulisers
  • 30mg prednisolone STAT + OD for 7 days
  • antibiotics if raised CRP/WCC or purulent sputum
  • CXR
  • consider NIV if T2FR + low pH
  • ITU referral if pH <7.25
20
Q

Outline non invasive ventilation

A
  • involves using a full face mask, hood or tight fitting nasal mask to blow air forcefully into the lungs + ventilate them
  • involves cycle of high (IPAP ~ 16-20) + low pressures (EPAP ~ 4-6)
21
Q

What does the COPD care bundle consist of?

A
  • inhaler technique review
  • smoking cessation support
  • referral to pulmonary rehabilitation
  • review of medications
  • follow up OP appointments
  • info about support groups, self-management booklets + oxygen alert card
22
Q

Common bacteria that cause COPD

A
  • Haemophilus influenzae
  • Streptococcus pneumoniae
  • Haemophilus parainfluenzae
  • Moraxella catarrhalis
    • how many need to know?
23
Q

Common viruses that cause COPD

A
  • rhinoviruses
  • coronavirus
  • influenza
  • parainfluenza
  • adenovirus
24
Q

Long term management of COPD

A
  • smoking cessation
  • pneumococcal + annual flu vaccine
  • pulmonary rehabilitation (exercise, nutritional advice + disease education)
  • long term oxygen therapy if chronic hypoxia
    .
  • initial medical treatment: SABA + SAMA e.g. salbutamol | ipratropium bromide
  • second step if no asthmatic or steroid responsive features: LABA + LAMA combination *e.g. anoro ellipta, utibro breezhaler**
  • second step if asthmatic or steroid responsive features: LABA + ICS combination ** *e.g. seretide, fostair
  • final step: LABA, LAMA + ICS combination e.g. trimbow
25
Q

Medication management of COPD

A
  • initial medical treatment: SABA + SAMA e.g. salbutamol | ipratropium bromide
  • second step if no asthmatic or steroid responsive features: LABA + LAMA combination *e.g. anoro ellipta, utibro breezhaler**
  • second step if asthmatic or steroid responsive features: LABA + ICS combination ** *e.g. seretide, fostair
  • final step: LABA, LAMA + ICS combination e.g. trimbow
26
Q

What therapies improve the symptoms of COPD?

A
  • pulmonary rehabilitation (exercise, nutritional advice + disease education)
  • bronchodilators
  • lung transplant
  • long term oxygen therapy
  • lung volume reduction surgery
  • mucolytics
27
Q

Outline long term oxygen therapy
When is it offered?

A
  • used to protect organs when hypoxic
  • used at least 16 hours/day
  • patient must not smoke + not retain high levels of CO2
  • offered if pO2 consistently <7.3kPa or <8kPa with cor pulmonale
28
Q

What therapies improves the risk of COPD?

A
  • stop smoking
  • oxygen therapy
  • anti inflammatories
  • non-invasive ventilation
  • flu vaccine
  • healthy diet
29
Q

When is ambulatory oxygen given?

A

If patient desaturates when they walk (>4%)

30
Q

What epithelial cells line the airways?

A

Ciliated pseudostratified columnar
Goblet cells

31
Q

How does exposure to triggers cause COPD?

A

Hypertrophy + hyperplasia of:
- bronchial mucinous glands (main bronchi)
- goblet cells (bronchioles)
Production of mucous > obstruction of airways

Smoking also shortens cilia > harder to move mucous

32
Q

FEV1 and FVC in patient with COPD

A

FEV1 - very low
FVC - low

33
Q

Complications of COPD

A
  • cor pulmonale
  • respiratory failure
  • pneumothorax
  • recurrent pneumonia
34
Q

How can COPD cause cor pulmonae (right sided heart failure)

A
  • vasoconstriction to a large proportion of lungs
  • increased pulmonary vascular resistance
  • pulmonary hypertension
  • more work for right side of heart
  • right sided heart failure
35
Q

How can alpha-1 antitrypsin deficiency causes COPD?

A
  • alpha-1 antitrypsin is a antiproteinase
  • the deficiency leads to an imbalance in proteinases + antiproteinases
  • this leads to destruction of alveolar walls + emphysema
36
Q

Typical colour of purulent sputum

A

Yellow or green

Respiratory System (25 decks)

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