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CI1 > COPD > Flashcards

COPD Flashcards

1
Q

What are some of the other names for COPD?

A
  • Chronic airflow limitation (CAL)
  • Chronic obstructive lung disease (COLD)
  • Chronic obstructive airway disease (COAD)
  • Obstructive lung disease (OLD)
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2
Q

What is COPD?

A
  • Progressive airflow limitation
  • Not fully reversible
  • Abnormal inflammatory response
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3
Q

What is the gold standard for diagnosing, assessing and monitoring COPD?

A

Spirometry - FEV1 is the best predictor of mortality

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4
Q

What spirometry values are indicative of COPD?

A
  • FEV1/FVC ratio < 70%

- FEV1 < 80% predicted after bronchodilator medication

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5
Q

What are the characteristics of mild COPD?

A
  • FEV1: 60-80% predicted
  • Few symptoms, no effect with ADL
  • No complications
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6
Q

What are the characteristics of moderate COPD?

A
  • FEV1 40-59% predicted
  • Increasing dyspnoea
  • Increasing limitation on ADL
  • Consider sleep apnoea
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7
Q

What are the characteristics of severe COPD?

A
  • FEV1 < 40% predicted
  • Dyspnoea on minimal exertion
  • ADLs severely affected
  • Complications include severe hypoxaemia, hypercapnia, pulmonary hypertension, heart failure
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8
Q

What conditions contribute to COPD?

A
  • Chronic bronchitis
  • Emphysema
  • Asthma
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9
Q

What causes an obstructive defect?

A
  • Partial occlusion of airway lumen
  • Inflammation of airway wall/bronchial smooth muscle constriction
  • Destruction of lung parenchyma (tissue surrounding conducting airways)
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10
Q

What are the characteristics of chronic bronchitis?

A
  • Patient coughs on most days at least 3 consecutive months for at least 2 years
  • Blue bloaters presentation common
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11
Q

What are the characteristics of pulmonary emphysema?

A
  • Permanent enlargement of airspaces distal to terminal bronchioles
  • Destruction of parenchyma
  • Collapsed airways
  • Pink puffers
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12
Q

What are some of the signs and symptoms of COPD?

A
  • Breathlessness
  • Cough/sputum production
  • Wheeze
  • Chest pain
  • Weight loss
  • Depression
  • Muscular weakness
  • Osteoporosis
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13
Q

What are the risk factors for COPD?

A
  • Genes
  • Tobacco smoke
  • Occupational dusts
  • Air pollution
  • Asthma
  • SES
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14
Q

How many pack years are associated with approx 80% of COPD patients?

A

History of at least 20 pack years

1 pack year = 20 cigarettes per day for 1 year

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15
Q

What are some of the evidence-based treatments for optimising function in COPD?

A
  • Bronchodilators
  • Pulmonary rehabilitation
  • Prevention/treatment of osteoporosis
  • Treatment of hypoxaemia & pulmonary hypertension
  • Surgical approach for some patients
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16
Q

What is the normal pressure for pulmonary circulation?

A

25/10mmHg

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17
Q

What is hypoxic pulmonary vasoconstriction?

A
  • Produced by smooth muscles cells in pulmonary arterioles
  • Can improve V/Q matching
  • Can increase the strain on the right side of the heart
18
Q

What factors in COPD lead to increased pulmonary artery pressures and right heat failure/strain?

A
  • Loss of vascular surface due to loss of lung parenchyma
  • Compression of vascular bed due to hyperinflation
  • Hyperviscosity of blood due to polycythemia
  • Left ventricular failure
  • Vessel changes due to inflammation
  • Pulmonary embolism
  • Hypoxic vasoconstriction
19
Q

What are the indications for home O2 in COPD?

A
  • Nocturnal O2 (SpO2 <88%)
  • Role in exercise as supplement
  • Arterial PaO2 < 55mmHg on room air at rest/awake
  • Daytime PaO2 55-59mmHg & evidence of organ damage/heart failure
20
Q

What are some of the evidence-based treatments for preventing deterioration in COPD?

A
  • Smoking cessation
  • Treatment of nicotine dependence
  • Influenza immunisation
  • Mucolytic medications
  • Long term oxygen therapy
21
Q

What are some of the exacerbations of COPD?

A
  • Increased dyspnoea
  • Increased sputum volume/purulence (pus)
  • Increased cough
  • Increased wheeze
  • Fever
  • URTI
22
Q

What are some of the causes of COPD exacerbations?

A
  • Respiratory infection (50%)
  • Congestive cardiac failure (25%)
  • Unknown causes (25%)
23
Q

What are some of the evidence-based treatments for managing exacerbations in COPD?

A
  • Early diagnosis/treatment
  • Inhaled bronchodilators
  • Systemic corticosteroids
  • Antibiotics
  • Controlled O2 delivery
24
Q

Why is residual volume higher in COPD patients?

A
  • Hyperinflation of the lungs due to loss of elastic recoil, enlarged spaces
  • Unable to exhale as much air due to airways collapsing during expiration (destroyed parenchyma = floppy)
  • Leaves higher residual volume (gas trapping)
25
Q

What are the indications of hyperinflation?

A
  • Barrel shaped chest
  • Upper chest pattern of breathing
  • Little lower chest expansion
  • CXR: Lung fields larger/blacker, diaphragm flatter, ribs more horizontal
26
Q

What is dynamic pulmonary hyperinflation (DPH)?

A
  • Compensatory strategy in response to airflow limitation
  • Results in increased end-expiratory lung volume above predicted RV
  • Decreases airway resistance allowing increase RR
  • Occurs during exercise
27
Q

What are the disadvantages of DPH?

A
  • Altered chest wall compliance

- Mechanical disadvantage of respiratory muscles

28
Q

What is the effect of hyperinflation on the diaphragm?

A
  • Length-tension relationship of fibres altered
  • Decreased zone of apposition
  • Medial orientation of fibres
  • Decreased curvature
  • Acts as fixator against abdominal contents
29
Q

What is pulmonary rehabilitation?

A
  • 8-12 week program of supervised exercise/education specific to COPD
  • Improves dyspnoea, exercise tolerance, QOL
30
Q

What is the impact dyspnoea in COPD?

A
  • Lack of fitness
  • Immobility
  • Social isolation
  • Depression
31
Q

What is inspiratory muscle training (IMT)?

A
  • Resisted breathing on inspiration
  • One-way spring-loaded valve
  • Mouth piece & nose clip
  • Resistance 9-41cmH2O (threshold)
32
Q

What intensity does IMT require to be effective in endurance athletes?

A

High intensity (> 50% max)

33
Q

What results have been found from IMT in endurance athletes?

A
  • Increased inspiratory muscle strength (MIP - maximum inspiratory pressure)
  • Increased exercise performance
34
Q

What are the mechanisms of improvement with IMT in endurance athletes?

A
  • No change in lung volumes
  • Increased diaphragm thickness
  • Increased limb perfusion (e.g. more blood to legs)
  • Decreased lactate (muscles require less O2)
  • Decreased neural drive
  • Decreased perceived exertion in breathing
35
Q

What is the evidence for IMT in COPD?

A
  • Increased inspiratory muscle strength/endurance
  • Decreased dyspnoea
  • Improved exercise tolerance
  • Improved QOL
  • Additional benefits to pulmonary rehab
  • Reduced hospitilisation days
36
Q

What are the training parameters for patients in the acute illness phase (ICU, mechanical ventilation)?

A
  • 5 days/week

- 5 sets of 6 breaths, rests in between (50% MIP, just able to complete 6th breath)

37
Q

What are the training parameters for patients with stable chronic COPD?

A
  • 3 days/week for minimum 8 weeks initially
  • > 30 % MIP
  • 2 mins on : 1 min off for 30 mins
  • Maintenance: 2 sessions/week forever
38
Q

Who is IMT for?

A

Acutely:

  • COPD/long term ICU patients
  • Main problem is dyspnoea

Long term:

  • Stable COPD
  • Addition to pulmonary rehab
  • Or if can’t attend pulmonary rehab
39
Q

What is maximum inspiratory pressure (MIP) a measure of?

A

Inspiratory muscle strength

40
Q

What are the contraindications/precautions to IMT in chronic COPD?

A
  • Recent undrained pneumothorax
  • History of recurrent spontaneous pneumothorax
  • Large bullae on CXR (big conjoined spaces, no elastic tissue, risk of pneumothorax)
  • Marked osteoporosis with history of spontaneous rib fractures
  • Lung surgery within last 12 months (speak to surgeon, negotiate)

CI1 (21 decks)

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