COPD Flashcards
what is the development of COPD proportional to
the no. cigarettes smoked a day
what is chronic bronchitis due to
neutrophilic inflammation
how does chronic bronchitis present
recurrent or chronic cough
is chronic bronchitis reversible
partially
what is emphysema due to
the action of neutrophil elastase and relates to an inc in proteases and a dec in antiproteases
impairs gas exchange - breathless
is emphysema reversible
NO
CB pathological findings
inc numbers of mucus secreting goblet cells and mucociliary dysfunction
what does mucus hypersecretion cause
productive cough
what happens to the SM
spasm and hypertrophy
what is the predominant lymphocytic infiltrate
CD8+ cell
what is inflammation of the walls followed by
scarring and thickening - narrows the small airways, this causes a wheeze
wheeze on expiration or inspriation
expiration
what is the underlying pathology in a blue bloater
CB
blue bloater
Decreased alveolar ventilation, low PaO2 and high PaCO2.
Cyanosed but not breathless, with wheeze and productive cough, and may go on to develop cor pulmonale.
Oxygen should be given with care.
how does the body respond to hypoxemia
making more RBC - polycythaemia
what is the definition of emphysema
abnormal enlargement of air spaces distal to terminal bronchioles due to loss of alveolar attachments and elastin breakdown
fewer but larger alveoli
emphysema process
macrophages stimulated and secrete proteases - attracts neutrophils which secrete elastase
elastase causes loss of elastic recoil
air trapping causing an inc in end expiratory volume
what is seen in PP
barrel chest
pursed lip breathing
eventually muscle wasting and weight loss
Pink puffer
Increased alveolar ventilation, normal PaO2 and normal or low PCO2. Breathless but not cyanosed.
May progress to type 1 resp failure.
what is barrel chest due to
use of expiratory muscles and inc end expiratory volume
what are signs of hypercapnia
CO2 flap and morning headache
what is centra acinar emphysema due to
smoking
what is pan acinar emphysema due to
alpha 1 antitrypsin deficiency
what does PFT show
low FVC and FEV1
reduced ratio and PEFR
what is the FEV1/FVC ratio reduced to
<70%
what is mild classed as
> 80% predicted
moderate
<80% predicted
severe
<50% predicted
v severe
<30% predicted
CXR
often normal
can show over inflation of lungs with flattened diaphragms (more than 6 ribs visible)
management steps
- SABA
- SABA + LAMA/LABA
- LABA + LAMA
what is the likely microbiology of an exacerbation
H influenza
M catarrhalis
S pneumonia
testing of acute exacerbation
sputum culture and purulence
CXR
when to treat acute exacerbation
inc in sputum purulence or CXR change or pneumonia
what antibiotics to give in acute exacerbation
amoxicillin
doxycycline 2nd line
treat acute exacerbation
Ipratropium Salbutamol Oxygen Amoxicillin Prednisolone
