COPD Flashcards
1
Q
COPD definition
A
disease state characterised by progressive airflow limitation that is not fully reversible
includes both chronic bronchitis and emphysema
2
Q
Chronic bronchitis definition
A
- chronic inflammation of a conducting airway
- causes a productive cough
- caused by cigarette smoking and CF
3
Q
Chronic bronchitis pathogenesis
A
- chronic inflammation stimulates submucosal mucus-secreting glands
- increased mucus secretion
- constriction of segmental bronchi or proximal bronchioles
- leads to irreversible fibrosis
4
Q
Signs of chronic bronchitis
A
- productive cough
- cyanosis due to hypoxaemia and hypercapnia (blue bloater)
- barrel chest
- vesicular breath sounds or mid-inspiratory crackles
- expiratory wheezing
- resp acidosis - high PCO2 and HCO3
5
Q
Emphysema definition
A
- breakdown of lung tissue in the respiratory unit
- leads to permanent enlargement and air trapping
- caused by cigarette smoking
6
Q
Emphysema pathogenesis
A
- cigarettes > neutrophil/macrophage chemotaxis, releasing elastase
- elastin sticks to outer surfaces of small airways, preventing collapse
- elastin is destroyed by the enzyme elastase and elastic recoil is lost
- leads to obstruction and barrel chest
7
Q
Signs of emphysema
A
- severe and early dyspnoea
- hyperventilation
- pursed lips (pink puffer)
- vesicular breath sounds but diminished due to air trapping
8
Q
COPD risk factors
A
- smoking
- age
- genetics (alpha-1 antitrypsin)
- childhood lung issues
9
Q
COPD pathophysiology
A
- chronic inflammation affecting central and peripheral airways, lung parenchyma, alveoli, vasculature
- repeated injury and repair leads to remodelling
- airway narrowing
- increased goblet cells
- larger mucus-secreting glands
- alveolar loss
- pulmonary hypertension
10
Q
COPD FEV1
A
- post-bronchodilator FEV1/FVC < 0.7
- > =80% - mild
- 50 - 79% - moderate
- 30 - 49% - severe
- under 30% - very severe
11
Q
MRC dyspnoea scale
A
1 - SOB on strenuous exercise
2 - SOB walking up hill
3 - SOB slows walking on flat ground
4 - SOB after 100m flat
5 - unable to leave house ∵ SOB
12
Q
COPD signs and symptoms
A
- morning cough that becomes constant
- sputum production
- shortness of breath
- barrel chest
- hyper-resonance
- wheezing
- coarse crackles
13
Q
COPD investigations
A
- FEV1/FVC less than 7 on spirometry
- oxygen saturation
- ABG
- chest X-ray
- full blood count
- ECG
- exercise testing
- alpha-1 antitrypsin
- sputum culture
14
Q
COPD management
A
- stop smoking (nicotine replacement, bupropion)
- annual flu jab
- pneumococcal vaccination
- pulmonary rehab for function
- SABA/SAMA e.g. ipratropium
- consider LAMA + ICS + LABA if asthma
- LABA + LAMA if not asthmatic
15
Q
COPD exacerbation
A
- H. influenzae, S pneumoniae, M. catarrhalis
- compensated respiratory acidosis
- sats 88-92% but normal target if bicarb normal
- give prednisolone 30mg via inhaler once daily for five days
- antibiotics if signs and symptoms of pneumonia - amoxicillin, clarithromycin or doxycycline
