COPD Flashcards
What is COPD
A chronic, slowly progressive disorder characterised by airflow obstruction that does not change markedly over several months
What are the major types of changes that occur in COPD
Structural and pathological
What are the 3 facets of the condition
Chronic bronchitis
Airway obstruction
emphysema
What is chronic bronchitis
A hypersecretory disorder defined as the presence of cough productive of sputum on most days for at least 3 months of 2 successive years
How is the diagnosis of chronic bronchitis made
On the basis of symptoms
What can be seen in the airways of patients with chronic bronchitis
Mucous gland hypertrophy and an increased number of goblet cells
What is airway obstruction
An increased resistance to airflow caused by difuse airway narrowing
What happens to the ratio in airway obstruction
It reduces
The ratio has to be less than what to be deemed to denote airway obstruction
0.7
What factors contribute to airway obstruction in COPD
destruction of alveoli by emphysema leads to a loss of elastic recoil and a loss of outward traction on the small airways such that they collapse on expiration
Airway inflammation with thickening of the airway wall
Accumulation of mucous secretions obstructing the airway lumen
What is emphysema
It is defined in terms of its pathological features that consist of dilatation of the terminal air spaces of the lung distal to the terminal bronchiole with destruction of their walls
What is emphysema
It is defined in terms of its pathological features that consist of dilatation of the terminal air spaces of the lung distal to the terminal bronchiole with destruction of their walls
what are the two main patterns of emphysema which are recognised
Centriacinar (centrilobular)
Panacinar (panlobular)
What does centriacinar emphysema involve
Emphysema involves damage around the respiratory bronchioles with preservation of the more distal alveolar ducts and alveoli
What does panacinar emphysema involve
Distension and destruction of the whole of the acinus and particularly affects the lower half of the lungs
What does panacinar emphysema involve
Distension and destruction of the whole of the acinus and particularly affects the lower half of the lungs
What type of emphysema is the characteristic feature of patients with alpha 1 anti-triypsin enzyme deficiency
Panacinar emphysema
Is there a higher prevalence of COPD in men or women
Men
Is there a higher prevalence of COPD in men or women
Men
What is the characteristic feature of emphysema and airways obstruction of COPD
Gradually progressive breathlessness sometimes associated with wheeze
What is the characteristic feature of emphysema and airways obstruction of COPD
Gradually progressive breathlessness sometimes associated with wheeze
What is used to confirm the presence of airflow obstruction
Spirometry
What is the severity of COPD based upon?
The post-bronchodilator spirometry
Can asthma and COPD coexist
Yes
What does total lung capacity and residual volume signify when they are elevated
Hyperinflation and air trapping
What are typically reduced in emphysema
Transfer factor for carbon monoxide and transfer coefficient
What are 2 complications of COPD
pneumothorax and bronchopneumonia
What is required to demonstrate the extent of emphysema and presence of bullae
High resolution CT scan
The medical research council dyspnoea scale is from 1 -5. what is the worst
Grade 5 - breathless when undressing
What other conditions are associated with COPD
Despression and anxiety
What is the key intervention in terms of COPD
Smoking cessation
What is the only proven disease modigying intervention for COPD
Smoking cessation - it alters the course of the disease
what are some side effects of nicotine withdrawl?
irritability
restlessness
anxiety
insomnia
what is a heavy smoker given ?
21mg/day for 4 weeks then 14mg/day for 2 weeks, then 7mg/day for 2 weeks nicotine patches
Is nicotine replacement therapy suitable in pregnancy
No
What are some of the side effects of Bupropion
epileptic seizures
What are some of the side effects of Varenicline
Nausea
headache
difficulty sleeping and abnormal dreams
What is the first line drug used for short term symptom relief and give an example of one
Short acting cholinergic drugs (Ipatropium)
What is the first line drug used for short term symptom relief and give an example of one
Short acting cholinergic drugs (Ipatropium)
What drugs give more prolonged relief of symptoms?
Long acting B2 agonists (salmetarol)
What is the advantage of using tiatropium over ipatropium
It has a longer half life and so is longer acting
How is disease progression most commonly defined
By the rate of decline in FEV1
The use of a combination inhalor typically produces how much of a reduction in exacerbation frequency
30%
Who are combination inhalors prescribed for
Those who have an FEV1 of
What is the function of inhaled corticosterdoids in COPD
There is no use and are not used in the management of COPD
What is the benefit of smoking cessation in COPD
The benefit is prognostic
What should be tested every time the patient is reviewed
Inhaler technique
How do the methylxanthines (aminophylline and theophyllines) work?
Stimulation of B adrenoceptors by inhibiting the metabolism of cAMP by the enzyme phospodiesterase
When should theophyllin be used
Only after a trial of SABA and LABAs
Why do plasma levels need to be monitored
The therapeutic window is narrow
What do the mucolytics do
Increase the expectoration of sputum by reducing its viscosity
Who are mucolytics recommended for?
Patients with a chronic cough productive of sputum
What is the first line psychological treatment for COPD
CBT
Describe the pulmonary rehabilitation programme
Multidisciplinary programme of care for patients with COPD that is individually taolored and designed to optimise the patient’s physical and social performance and autonomy
What can pulmonary rehabilitation do
Reduce dyspnoea, improve exercise tolerance and quality of life
What does hypoxia within the lungs lead to?
Pulmonary vasoconstriction
What is the term given to right heart failure caused by lung disease
cor pulmonale
What is often the first sign of cor pulmonale
Ankle swelling
How is oxygen therapy useful in COPD
improved survival in patients with severe airflow obstruction and hypoxia
Who is long term home oxygen therapy indicated for
Patients with severe COPD and persistent hypoxia
how is long term oxygen usually given
via nasal cannulae at a flow rate of about 2L/ min
What does an oxygen concentrator do?
It separates oxygen from the ambient air using a molecular sieve. Installed in the patient’s house and plastic tubing relays oxygen to points such as the the bedroom and living room.
What is the main aim of long term oxygen therapy
to improve prognosis rather than to alleviate symptoms if it is complied to for 15h/day
Who is ambulatory oxygen appropriate for?
Patients who are active enough to leave the home regularly who demonstrate a fall in oxygen saturation to below 90% on exercise and who show symptomatic benfit from oxygen in terms of walking distance
Who is ambulatory oxygen appropriate for?
Patients who are active enough to leave the home regularly who demonstrate a fall in oxygen saturation to below 90% on exercise and who show symptomatic benefit from oxygen in terms of walking distance
What is short -burst oxygen
The use of oxygen for short periods to relieve dyspnoea after exercise
What are patients with lung disease vulnerable to developing when travelling by plane
Hypoxia
When would a bullectomy be appropriate
Where a large bulla is compressing surrounding viable lung
Who is lung volume reduction surgery an option for?
Selected patients with severe disability
What is the aim of volume reduction surgery
To resect funcitonally useless areas of lung and thereby reducing the overall volume of the lungs in oder to restore elastic recoil so that there is an increased outward traction on the small airways
What is involved in the self - management plan of COPD
Th patient increases the dose and frequency of bronchodilator medication and starts a course of oral prednisolone and an antibiotic
What can determine whether a patient can be managed at home
Severity of COPD (basline FEV1, SpO2, exercise capacity
Home circumstances (family support)
Key adverse features of a severe exacerbation (confusion, cyanosis, severe respiratory distress)
When should blood cultures be taken in an exacerbation of COPD
If the patient is pyrexial
What are the 2 main types of bronchodilator therapy usually given and how
Combination of salbutamol (neb) and ipatriopium (neb) with predisolone
What are the 3 most common types of bacteria that are found in exacerbation of COPD
Haemophilus influenzae, Streptococcus pneumoniae or Moraxella catarrhalis
What is the main antibiotic given in exacerbations?
Amoxicillin
How much oxygen should be given to a patient with an exacerbation of COPD (% and mask type)
28% venturi mask
What is the target saturation for COPD patients
88-92%
What is the target saturation for COPD patients
88-92%
What is the time limit of using oxygen when giving a drug nebulised?
10 minutes
What is the most common type of ABG result in COPD patients
Respiratory acidosis
What should be done if the pH range is less than normal in COPD
Non-Invasive Ventilation
What is the benefit of using non-invasive ventilation
It reduces inpatient mortality by 50%
What should be used in patients who are unable to tolerate NIV
Doxapram (respiratory stimulant) or invasive ventilation
What is the mneumonic for Emergency COPD
i - ipratropium S - Salbutamol O - Oxygen A - amoxicillin P - prednisolone
