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COPD Flashcards

1
Q

What is COPD?

A

Chronic obstructive pulmonary disease

Umbrella term for chronic bronchitis and emphysema

Progressive disorder characterised by irreversible airflow limitation and persistent inflammatory response in the lungs

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2
Q

How can you define COPD?

A

FEV1/FVC ratio less than 0.7

OR

FEV1 less than 80% of predicted

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3
Q

What is FEV1/FVC ratio?

A

The proportion of a person’s vital capacity that they are able to expire in the first second of forced expiration.

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4
Q

What is your typical COPD patient like?

A

Over 35 years

Exposed to smoking (actively or passively) or pollution

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5
Q

How can you diagnose COPD?

A

Spirometry

FEV1/FVC ratio less than 0.7
FEV1 less than 80% of predicted

As well as clinical history: respiratory symptoms such as cough, SOB

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6
Q

What is emphysema?

A

Destruction of lung parenchyma:
alveoli and respiratory bronchioles

This leads to floppy enlarged airspaces

Loss of elastic recoil

Expiratory flow limitation and air trapping

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7
Q

What is the clinical picture for patients with predominant emphysema?

A

Pink puffer

Increased alveolar ventilation
Near normal PaO2 and PaCO2

Breathless but not cyanosed

Weight loss

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8
Q

What is the clinical picture for patients with predominant chronic bronchitis?

A

Blue bloater

Decreased alveolar ventilation
Low PaO2, high PaCO2

Cyanosed but not breathless

Cough with phlegm

May go on to develop cor pulmonale

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9
Q

What is cor pulmonale?

A

Abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels.

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10
Q

What happens to respiratory drive in patients with predominant chronic bronchitis?

A

Their respiratory centres become insensitive to CO2

They therefore rely on hypoxic drive to maintain their respiratory effort

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11
Q

You rarely see the exact phenotypes of pink puffers are blue bloaters.

True or false?

A

True

Most patients have a combo of both emphysema and chronic bronchitis

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12
Q

What is chronic bronchitis?

A

Airway narrowing and airflow limitation as a result of:

  • Hypertrophy and hyperplasia of mucus secreting glands: mucus hyper-secretion
  • Bronchial wall inflammation
  • Mucosal oedema

Epithelial cell metaplasia (columnar to squamous)

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13
Q

In COPD, are the smaller airways involved?

If they are, in what way?

A

Yes

They are involved early

  • Peribronchial fibrosis
  • Airway narrowing and obliteration
  • Inflammation with exudates
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14
Q

In COPD is the vascular component of lungs involved?

If so, in what way?

A

Yes

Intimal thickening and endothelial destruction

Hypertrophy of smooth muscle and collagen deposition

Progressive obliteration of the capillary bed

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15
Q

In terms of leukocytes, what is the difference between asthma and COPD?

A

Asthma: CD4 lymphocytes and eosinophils

COPD: CD8 lymphocytes, macrophages, neutrophils, eosinophils

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16
Q

Is COPD obstructive or restrictive?

A

Obstructive

17
Q

What is the difference between obstructive and restrictive lung disease?

A

Obstructive lung diseases include conditions that make it hard to exhale all the air in the lungs.

People with restrictive lung disease have difficulty fully expanding their lungs with air.

18
Q

What is the link between alpha-1 antitrypsin and COPD?

A

A deficiency of alpha-1 antitrypsin is a cause of early onset COPD

19
Q

What is alpha-1 antitrypsin?

A

It inhibits a wide variety of proteases.

Protecting tissues from enzymes of inflammatory cells, especially neutrophil elastase.

20
Q

Why does alpha-1 antitrypsin deficiency cause COPD?

A

A lack of alpha-1 antitrypsin means that neutrophil elastase is free to break down elastin,

Elastin contributes to the elasticity of the lungs

No elastin results in lack of lung elasticity = COPD

21
Q

What are the symptoms of COPD?

A

Breathlessness
Cough (smokers cough)
Phlegm (winter bronchitis)

Cyanosis
Signs of CO2 retention

Barrel shaped, hyper-expanded chest

All the signs of cor pulmonale

Weight loss

22
Q

What are the signs of CO2 retention?

A

Uncontrollable flapping of hands

Confusion

23
Q

What are the signs of cor pulmonale?

A

Cor pulmonale = R heart hypertrophy due to lung disorder

Chest pain
Syncope
Swelling of ankles

24
Q

What is the MRC dyspnoea scale?

A
  1. SOB on exertion
  2. SOB on hills
  3. Having to slow or stop on flat
  4. Can’t go more than 100-200 yards on flat
  5. Housebound / SOB on minor tasks
25
Q

What is the differential diagnosis of COPD symptoms?

A 
Heart failure
PE
Pneumonia
Lung cancer
Asthma
Bronchiectasis
26
Q

What are the signs of COPD?

A

Tachypnoea

Hyperinflation

Decreased cricosternal distance

Quiet breath sounds

27
Q

What are the complications that can arise from COPD?

A

Respiratory failure

Cor pulmonale

Acute exacerbations

Pneumothorax

28
Q

What are exacerbations?

A

A flare-up or episode with increase in symptoms above and beyond normal variation for more than 2 days

It is most often linked to an infection.

Exacerbations can be serious.

29
Q

Investigations for COPD?

A

Blood: raised haematocrit

CXR: look for hyperinflation

ECG: RA or RV hypertrophy

ABG: Low PaO2 and raised PaCO2

Lung function tests:

  • Spirometry
  • Peak flow
30
Q

What is the clinical course of COPD?

A

Gets progressively worse over time

Punctuated with exacerbations

31
Q

Non-pharmological treatment of COPD.

A

Smoking cessation
Generally improve lifestyle

Vaccination against flu that causes exacerbations

Pulmonary rehabilitation

  • aerobic and resistance training
  • education
32
Q

What are the benefits of pulmonary rehabilitation?

A

Improvements in exercise capacity, QoL, breathlessness

Shorter stays in hospital

33
Q

Pharmological treatment of COPD?

A

Mucolytics: may help productive cough

Anti-muscarinics: bronchial vasodilation

Long acting B2 agonists

Steroids if still uncontrolled

Respiratory (17 decks)

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