COPD Flashcards

1
Q

Phenotypes

A

How a disease appears at a macroscopic level

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2
Q

Endotypes

A

Relate to the underlying disease mechanisms

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3
Q

What is copd characterised by?

A

airway obstruction (FEV1

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4
Q

how is emphysema defined?

A

histologically

enlarged air spaces distal to terminal bronchioles, with destruction of alveolar walls

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5
Q

how is chronic bronchitis defined?

A

clinically

cough, sputum production on most days for 3 months of 2 successive years

symptoms improve if they stop smoking

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6
Q

RFs for COPD

A

> 35 yrs, smoking
pollution related
chronic dyspnoea
sputum production

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7
Q

whats the major site of airflow obstruction?

A

smaller airways

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8
Q

alveolar membranes break down. e or cb?

A

emphysema

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9
Q

inflammation and excess mucus in small airways. e or cb?

A

chronic bronchitis

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10
Q

inflammatory profile of COPD

A

CD8 lymphocytes, macrophages, neutrophils

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11
Q

how is the normal airway held open?

A

tethering effect of the alveolar walls (with elastin fibres)

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12
Q

why is the expiratory limb of the flow volume loop typically “scoped” in COPD?

A

mid expiratory flow is compromised as airways collapse

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13
Q

pink puffers (a phenotype)

A

increased alveolar ventilation, near normal PaO2 and a normal or low PaCO2.

Breathless but not cyanosed

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14
Q

blue bloaters (a phenotype)

A

have decreased alveolar ventilation, with a low PaO2 and a high PaCO2

Cyanosed but not breathless.

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15
Q

Which phenotype may progress to type 1 resp failure?

A

pink puffers

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16
Q

what do the resp centres in blue bloaters rely on to maintain resp effort?

A

hypoxic drive (as are relatively insensitive to CO2)

17
Q

symptoms

A

cough, sputum, dyspnoea, wheeze

18
Q

night time waking with breathlessness +/- wheeze?

A

asthma

19
Q

signs of COPD

A

tachypnoea
use of accessory muscles of resp, hyperinflation
barrel shaped chest

20
Q

complications of COPD

A

acute exacerbations +/- infection

21
Q

what would CXR show?

A

hyperinflation
flat hemi diaphragms
large central pulmonary arteries
bullae

22
Q

ECG may show?

A

RA and LV hypertrophy (cor pulmonae)

23
Q

Management for chronic stable

A

general: smoking, exercise, nutrition

short-acting antimuscarinic e.g. ipratropium, or B2 agonist

24
Q

Management for mild/moderate

A

inhaled LA antimuscarinic or B2 agonist

25
Q

Management for severe

A

combination LABA + corticosteroids e.g. symbicort or tiotriopium

26
Q

Tx for exacerbation

A

antibiotics/bronchodilaotrs
steroids
o2 with care