COPD Flashcards
what is the definition of chronic bronchitis and what is the pathological change that is seen?
this is the pathological hypersecretion of mucus on most days for 3 months over 2 years. (excluding TB, or any other cause)
what happens is that the normal bronchial cells, with their cilia and damaged by recurrent insults. Then the mucus cells hypersecrete
(note this is a bronchial disease, not alveolar - hence i am not saying type 1 or 2 pneumocytes)
what is the ratio as defined by GOLD for obstructive disease?
0.7
what is the requirement for restrictive lung disease on spirometry?
reduced total lung capacity.
don’t be tricked into interpreting reduced FVC as restrictive. (obstructive disease with gas trapping may decrease the FVC)
what is the level of the MEF50 in emphysema?
versus asthma?
the MEF50 is very low in very bad emphysematous disease.
in asthma it is mildly decreased, but not as bad
this is because the dynamic airway obstruction is so severe in those patients
what is the meaning of dynamic hyperinflation in emphysema?
basically, as empysemics exercise, there is gas trapping with exercise. This means that the residual capacity goes up , and their tidal volume is not increased (maybe even goes down)
this is a cause of severe breathlessness
what does asthma do to TLco (DLco)?
what about emphysema?
DLco goes up with asthma
goes down with emphysema
does NIV have any role in COPD?
yes
evidence suggests it reduces mortality
prevents intubation
it is the only thing that reduces risk of intubation
what are the two things that have been shown to reduce long term mortality in COPD?
LTOT when hypoxic (PaO2 < 55; <60 with cor pulmonale)
smoking cessation
what is the role of lung reduction surgery?
which patients are appropriate for this?
this is a procedure that increased lung recoil and led to improved FEV1, dyspnoea, QOL and walking distance
HOWEVER, there was no mortality benefit.
should be limited to people with normal CO2 and RV pressure. Best to offer to patients with heterogenous hyperinflation
what are the benefits of pulmonary rehab?
improves exercise capabilities
improves dyspnoea symptoms
reduces number of hospitalisations and length of stay
what is the role of tiotropium?
long acting anti muscarinic
this drug improves QOL, FEV1 and reduces exac, hospitalisation and resp failure
once again - no mortality benefit
what are the things to do when someone has an acute exacerbation?
the treatments with evidence are oral steroids and oral antibiotics
what is the definition of an acute exacerbation of COPD?
there’s not a single great answer
probably increased symptomatology. A clear guide for antibiotics is not well established.
what is the role of inhaled steroids?
look this up in delta med notes
be aware that if you have a question asking about reduced exacerbations, the patient first needs to HAVE exacerbations!
how do inhaled beta agonists reduce SOB and improve exercise tolerance in patients with COPD?
apparently it is through reduced dynamic hyperinflation
there was a thought that increased FEV1 played a role, but this is less clear. Especially with regards to the improved ET that the question asks
