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Respiratory Conditions (JBR) > COPD > Flashcards

COPD Flashcards

1
Q

What kind of airway disease is COPD?

A

Obstructive

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2
Q

What makes up COPD?

A

Chronic bronchitis

Emphysema

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3
Q

What are the histopathological features of COPD?

A

Mucociliary dysfunction
Inflammation
Tissue damage

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4
Q

How does COPD change over time?

A

Progressive condition

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5
Q

What causes COPD?

A

Smoking and exposure to inhaled noxious particles and gases

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6
Q

How does cigarette smoke or another irritant lead to progressive airflow limitation?

A

Activates macrophages and cells which release neutrophil chemotactic factors (IL-8), mediators (LTB4) and oxygen radicals
Neutrophils and macrophages release proteases that break down connective tissues in parenchyma and cause mucous hypersecretion
= Progressive airflow limitation

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7
Q

Connective tissue in the parenchyma breaks down because of an imbalance between?

A

Proteases and anti-proteases

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8
Q

What is emphysema?

A

Irreversible alveolar wall destruction resulting in impaired gas exchange and loss of bronchial support

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9
Q

Alpha-1-anti-trypsin is an inhibitor of?

A

Proteases

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10
Q

What is the chronic cascade?

A 
Progressive fixed airflow obstruction 
Impaired gas exchange 
Respiratory failure (decreased PaO2, increased PaCO2) 
Pulmonary hypertension
RVH
Right Ventricular Heart failure 
Cor pulmonale 
Death
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11
Q

What are chronic symptoms of COPD?

A 
Smoking 
Non-atopic
Daily productive cough
(progressive) Breathlessness
Wheezing (bronchitis) 
Reduced breath sounds (emphysema) 
Worsening quality of life 
Exacerbation (frequent/infective) 
Reduced lung function
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12
Q

What are acute symptoms of COPD?

A

Respiratory distress
Wheeze
Coarse crackles
Possible cyanosis

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13
Q

How do you assess someone at high risk?

A

Spirometry
FEV1 less than 50% predicted
2 or more exacerbates within past year
Co-morbidities - IHF / HF

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14
Q

What are the features of COPD on spirometry?

A

Reduced FVC and total lung capacity
Reduced FEV1
FEV1/FVC ratio <75%
<15% FEV1 response to salbutamol

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15
Q

What are non-pharmacological management options for COPD?

A

Stop smoking (stop further decrease in lung function)
Physical activity
Oxygen
Lung volume reduction surgery

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16
Q

Which drug can reduce parasympathetic activity to improve symptoms in COPD?

A

Muscarinic Acetylcholine Receptor Antagonists

17
Q

What is the mechanism of action of a Muscarinic Acetylcholine Receptor antagonist?

A

Block activation by muscarinic receptor antagonists

M3 receptor = parasympathetic fibres

18
Q

What are examples of a SAMA?

A

Ipratropium

Oxitropium

19
Q

What receptors does Ipratropium act on?

A

Non-selective blocker of M1, M2 and M3

20
Q

What is an example of a LAMA?

A

Tiotropium

Aclidinium

21
Q

What feature of Tiotroprium and Ipratroprium reduces adverse effects by reducing absorption and system exposure?

A

Quaternary ammonium group

22
Q

How are muscarinic receptor antagonists administered?

A

Inhalation

23
Q

Why is blocking of the M2 receptor not desireable?

A

Because release of ACh from parasympathetic post-ganglionic neurone is increased

24
Q

What are examples of LABAs?

A

Salmeterol

Formeterol

25
Q

What are examples of combination inhalers used in COPD?

A

LAMA-LABA

LABA-ICS

26
Q

What is an example of a PDE4 inhibitor?

A

Rofumilast

27
Q

What are side effects of Rofumilast?

A

Nausea
Diarrhoea
Headache
Weight loss

28
Q

Where PDE expressed?

A

Neutrophils
T-cells
Macrophages

29
Q

Inhibition of PDE4 may have inhibitory effects on?

A

Inflammatory / Immune cells

30
Q

What is the effect of PDE4 inhibitors?

A

Suppress inflammation and emphysema

31
Q

What is an example of a mucolytic?

A

Carbocisteine

32
Q

What is the effect of carbocisteine?

A

Reduce sputum viscosity and aide septum expectoration

33
Q

How is an acute exacerbation of COPD treated?

A 
(iSOAP - BUZZ)
Ipratroprium
Salbutamol (nebulised, high-dose) 
Oxygen (24-28% - titrated against PaO2/PaCO2) 
Amoxicillin/Doxycycline (if infection) 
Prednisolone (oral)
34
Q

Normally non-invasive ventilation for a higher FiO2 is used; when would ITU intubated assisted ventilation be used?

A

Only if reversible component, i.e. pneumonia

Respiratory Conditions (JBR) (26 decks)

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