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Respiratory (LECTURE NOTES) > COPD > Flashcards

COPD Flashcards

1
Q

What is COPD

A

A chronic, slowly progressive disorder characterised by airflow obstruction that does not change markedly over several months

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2
Q

What are the major types of changes that occur in COPD

A

Structural and pathological

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3
Q

What are the 3 facets of the condition

A

Chronic bronchitis
Airway obstruction
emphysema

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4
Q

What is chronic bronchitis

A

A hypersecretory disorder defined as the presence of cough productive of sputum on most days for at least 3 months of 2 successive years

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5
Q

How is the diagnosis of chronic bronchitis made

A

On the basis of symptoms

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6
Q

What can be seen in the airways of patients with chronic bronchitis

A

Mucous gland hypertrophy and an increased number of goblet cells

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7
Q

What is airway obstruction

A

An increased resistance to airflow caused by difuse airway narrowing

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8
Q

What happens to the ratio in airway obstruction

A

It reduces

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9
Q

The ratio has to be less than what to be deemed to denote airway obstruction

A

0.7

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10
Q

What factors contribute to airway obstruction in COPD

A

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

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11
Q

What is emphysema

A

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

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12
Q

What is emphysema

A

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

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13
Q

what are the two main patterns of emphysema which are recognised

A

Centriacinar (centrilobular)

Panacinar (panlobular)

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14
Q

What does centriacinar emphysema involve

A

Emphysema involves damage around the respiratory bronchioles with preservation of the more distal alveolar ducts and alveoli

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15
Q

What does panacinar emphysema involve

A

Distension and destruction of the whole of the acinus and particularly affects the lower half of the lungs

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16
Q

What does panacinar emphysema involve

A

Distension and destruction of the whole of the acinus and particularly affects the lower half of the lungs

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17
Q

What type of emphysema is the characteristic feature of patients with alpha 1 anti-triypsin enzyme deficiency

A

Panacinar emphysema

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18
Q

Is there a higher prevalence of COPD in men or women

A

Men

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19
Q

Is there a higher prevalence of COPD in men or women

A

Men

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20
Q

What is the characteristic feature of emphysema and airways obstruction of COPD

A

Gradually progressive breathlessness sometimes associated with wheeze

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21
Q

What is the characteristic feature of emphysema and airways obstruction of COPD

A

Gradually progressive breathlessness sometimes associated with wheeze

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22
Q

What is used to confirm the presence of airflow obstruction

A

Spirometry

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23
Q

What is the severity of COPD based upon?

A

The post-bronchodilator spirometry

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24
Q

Can asthma and COPD coexist

A

Yes

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25
Q

What does total lung capacity and residual volume signify when they are elevated

A

Hyperinflation and air trapping

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26
Q

What are typically reduced in emphysema

A

Transfer factor for carbon monoxide and transfer coefficient

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27
Q

What are 2 complications of COPD

A

pneumothorax and bronchopneumonia

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28
Q

What is required to demonstrate the extent of emphysema and presence of bullae

A

High resolution CT scan

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29
Q

The medical research council dyspnoea scale is from 1 -5. what is the worst

A

Grade 5 - breathless when undressing

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30
Q

What other conditions are associated with COPD

A

Despression and anxiety

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31
Q

What is the key intervention in terms of COPD

A

Smoking cessation

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32
Q

What is the only proven disease modigying intervention for COPD

A

Smoking cessation - it alters the course of the disease

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33
Q

what are some side effects of nicotine withdrawl?

A

irritability
restlessness
anxiety
insomnia

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34
Q

what is a heavy smoker given ?

A

21mg/day for 4 weeks then 14mg/day for 2 weeks, then 7mg/day for 2 weeks nicotine patches

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35
Q

Is nicotine replacement therapy suitable in pregnancy

A

No

36
Q

What are some of the side effects of Bupropion

A

epileptic seizures

37
Q

What are some of the side effects of Varenicline

A

Nausea
headache
difficulty sleeping and abnormal dreams

38
Q

What is the first line drug used for short term symptom relief and give an example of one

A

Short acting cholinergic drugs (Ipatropium)

39
Q

What is the first line drug used for short term symptom relief and give an example of one

A

Short acting cholinergic drugs (Ipatropium)

40
Q

What drugs give more prolonged relief of symptoms?

A

Long acting B2 agonists (salmetarol)

41
Q

What is the advantage of using tiatropium over ipatropium

A

It has a longer half life and so is longer acting

42
Q

How is disease progression most commonly defined

A

By the rate of decline in FEV1

43
Q

The use of a combination inhalor typically produces how much of a reduction in exacerbation frequency

A

30%

44
Q

Who are combination inhalors prescribed for

A

Those who have an FEV1 of

45
Q

What is the function of inhaled corticosterdoids in COPD

A

There is no use and are not used in the management of COPD

46
Q

What is the benefit of smoking cessation in COPD

A

The benefit is prognostic

47
Q

What should be tested every time the patient is reviewed

A

Inhaler technique

48
Q

How do the methylxanthines (aminophylline and theophyllines) work?

A

Stimulation of B adrenoceptors by inhibiting the metabolism of cAMP by the enzyme phospodiesterase

49
Q

When should theophyllin be used

A

Only after a trial of SABA and LABAs

50
Q

Why do plasma levels need to be monitored

A

The therapeutic window is narrow

51
Q

What do the mucolytics do

A

Increase the expectoration of sputum by reducing its viscosity

52
Q

Who are mucolytics recommended for?

A

Patients with a chronic cough productive of sputum

53
Q

What is the first line psychological treatment for COPD

A

CBT

54
Q

Describe the pulmonary rehabilitation programme

A

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

55
Q

What can pulmonary rehabilitation do

A

Reduce dyspnoea, improve exercise tolerance and quality of life

56
Q

What does hypoxia within the lungs lead to?

A

Pulmonary vasoconstriction

57
Q

What is the term given to right heart failure caused by lung disease

A

cor pulmonale

58
Q

What is often the first sign of cor pulmonale

A

Ankle swelling

59
Q

How is oxygen therapy useful in COPD

A

improved survival in patients with severe airflow obstruction and hypoxia

60
Q

Who is long term home oxygen therapy indicated for

A

Patients with severe COPD and persistent hypoxia

61
Q

how is long term oxygen usually given

A

via nasal cannulae at a flow rate of about 2L/ min

62
Q

What does an oxygen concentrator do?

A

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.

63
Q

What is the main aim of long term oxygen therapy

A

to improve prognosis rather than to alleviate symptoms if it is complied to for 15h/day

64
Q

Who is ambulatory oxygen appropriate for?

A

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

65
Q

Who is ambulatory oxygen appropriate for?

A

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

66
Q

What is short -burst oxygen

A

The use of oxygen for short periods to relieve dyspnoea after exercise

67
Q

What are patients with lung disease vulnerable to developing when travelling by plane

A

Hypoxia

68
Q

When would a bullectomy be appropriate

A

Where a large bulla is compressing surrounding viable lung

69
Q

Who is lung volume reduction surgery an option for?

A

Selected patients with severe disability

70
Q

What is the aim of volume reduction surgery

A

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

71
Q

What is involved in the self - management plan of COPD

A

Th patient increases the dose and frequency of bronchodilator medication and starts a course of oral prednisolone and an antibiotic

72
Q

What can determine whether a patient can be managed at home

A

Severity of COPD (basline FEV1, SpO2, exercise capacity
Home circumstances (family support)
Key adverse features of a severe exacerbation (confusion, cyanosis, severe respiratory distress)

73
Q

When should blood cultures be taken in an exacerbation of COPD

A

If the patient is pyrexial

74
Q

What are the 2 main types of bronchodilator therapy usually given and how

A

Combination of salbutamol (neb) and ipatriopium (neb) with predisolone

75
Q

What are the 3 most common types of bacteria that are found in exacerbation of COPD

A

Haemophilus influenzae, Streptococcus pneumoniae or Moraxella catarrhalis

76
Q

What is the main antibiotic given in exacerbations?

A

Amoxicillin

77
Q

How much oxygen should be given to a patient with an exacerbation of COPD (% and mask type)

A

28% venturi mask

78
Q

What is the target saturation for COPD patients

A

88-92%

79
Q

What is the target saturation for COPD patients

A

88-92%

80
Q

What is the time limit of using oxygen when giving a drug nebulised?

A

10 minutes

81
Q

What is the most common type of ABG result in COPD patients

A

Respiratory acidosis

82
Q

What should be done if the pH range is less than normal in COPD

A

Non-Invasive Ventilation

83
Q

What is the benefit of using non-invasive ventilation

A

It reduces inpatient mortality by 50%

84
Q

What should be used in patients who are unable to tolerate NIV

A

Doxapram (respiratory stimulant) or invasive ventilation

85
Q

What is the mneumonic for Emergency COPD

A 
i - ipratropium
S - Salbutamol
O - Oxygen
A - amoxicillin
P - prednisolone

Respiratory (LECTURE NOTES) (19 decks)

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