COPD Flashcards

1
Q

What is the definition of COPD?

A

Chronic obstructive pulmonary disease
Poorly reversible airflow limitation that is usually progressive
FEV1/FVC <0.7
FEV < 80%

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2
Q

What is the pathology of COPD?

A
  • Associated with persistent inflammatory response of the lungs
  • Chronic bronchitis
  • Airway narrowing = airflow limitation
  • Hypertrophy and hyperplasia of mucus secreting glands
  • Bronchial wall inflammation
  • Mucosal oedema
  • Epithelial cell layer may ulcerate
  • Squamous epithelium may replace columnar epithelium when ulcers heal = squamous metaplasia
  • ‘Blue bloaters’ = bronchitis>emphysema
  • Emphysema
  • Dilatation and destruction of the lung tissue distil to the terminal bronchioles
  • Loss of elastic coil
  • Expiratory air flow limitation and air trapping
  • ‘Pink puffer’ = emphysema>bronchitis
  • Smoking
  • Causes mucous gland hypertrophy in larger airways
  • ↑ in neutrophils, macrophages and lymphocytes in the walls
  • α1 – antitypsin deficiency is inactivated by cigarette smoke
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3
Q

What are the risk factors/aetiology of COPD?

A
  • Smoking
  • Exposure to pollutants e.g. mining, building, chemical industries
  • Outdoor air pollutions
  • Inhalation of smoke e.g. biomass fuels
  • Alpha-1 antitrypsin deficiency – early onset
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4
Q

What are the signs/symptoms of COPD?

A
•	Productive cough – inc. purulent sputum 
•	Wheeze
•	Breathlessness at rest
•	Prolonged expiration
•	Poor chest expansion
•	Lung hyperinflation – loss of cardiac and liver dullness
•	Cyanosis 
•	Oedema
•	CO2 retention
•	warm peripheries
•	bounding pulse
•	flapping tremor
•	confusion
Thin with loss of muscle mass
Pursed lip breathing
Increased work of breathing:
Leaning forward
Accessory muscles of respiration
Tracheal tug
Nasal flare
Paradoxical abdominal movement
Indrawing of intercostal muscles
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5
Q

What investigation are conduced for suspected COPD?

A
  • Lung function tests
  • Peak flow
  • Spirometry
  • CXR
  • CT
  • FBC – haem and packed cell volume may be high due to persistent hypoaemia
  • ABG
  • α1 – antitypsin serum levels
  • EGC – for cor pulmonale
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6
Q

What are the surgical treatments for COPD?

A
  • Bullectomy – for patients with large emphysematous bullae

* Lung volume reduction surgery - severe

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7
Q

What are the pharmacological treatments for COPD?

A
  • Bronchodialators – e.g. tiotropium bromide
  • Corticosteroids e.g. prednisolone
  • Abx – rescue pack for acute exacerbations
  • Pneumococcal vaccine
  • Mucolytics
  • Diuretics – for oedema
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8
Q

What are the non pharmacological treatments for COPD?

A
  • Smoking cessation
  • Oxygen
  • Exercise training
  • High calorie diet
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