COPD Flashcards
Phenotypes
How a disease appears at a macroscopic level
Endotypes
Relate to the underlying disease mechanisms
What is copd characterised by?
airway obstruction (FEV1
how is emphysema defined?
histologically
enlarged air spaces distal to terminal bronchioles, with destruction of alveolar walls
how is chronic bronchitis defined?
clinically
cough, sputum production on most days for 3 months of 2 successive years
symptoms improve if they stop smoking
RFs for COPD
> 35 yrs, smoking
pollution related
chronic dyspnoea
sputum production
whats the major site of airflow obstruction?
smaller airways
alveolar membranes break down. e or cb?
emphysema
inflammation and excess mucus in small airways. e or cb?
chronic bronchitis
inflammatory profile of COPD
CD8 lymphocytes, macrophages, neutrophils
how is the normal airway held open?
tethering effect of the alveolar walls (with elastin fibres)
why is the expiratory limb of the flow volume loop typically “scoped” in COPD?
mid expiratory flow is compromised as airways collapse
pink puffers (a phenotype)
increased alveolar ventilation, near normal PaO2 and a normal or low PaCO2.
Breathless but not cyanosed
blue bloaters (a phenotype)
have decreased alveolar ventilation, with a low PaO2 and a high PaCO2
Cyanosed but not breathless.
Which phenotype may progress to type 1 resp failure?
pink puffers
what do the resp centres in blue bloaters rely on to maintain resp effort?
hypoxic drive (as are relatively insensitive to CO2)
symptoms
cough, sputum, dyspnoea, wheeze
night time waking with breathlessness +/- wheeze?
asthma
signs of COPD
tachypnoea
use of accessory muscles of resp, hyperinflation
barrel shaped chest
complications of COPD
acute exacerbations +/- infection
what would CXR show?
hyperinflation
flat hemi diaphragms
large central pulmonary arteries
bullae
ECG may show?
RA and LV hypertrophy (cor pulmonae)
Management for chronic stable
general: smoking, exercise, nutrition
short-acting antimuscarinic e.g. ipratropium, or B2 agonist
Management for mild/moderate
inhaled LA antimuscarinic or B2 agonist
Management for severe
combination LABA + corticosteroids e.g. symbicort or tiotriopium
Tx for exacerbation
antibiotics/bronchodilaotrs
steroids
o2 with care
