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2.3.4. Respiratory System > COPD > Flashcards

COPD Flashcards

1
Q

Define COPD

A

characterised by airflow obstruction. The airflow obstruction is usually progressive, not fully reversible and does not change markedly over several months. The disease is predominantly caused by smoking

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2
Q

COPD is an umbrella term encompassing what?

A

Emphysema = destruction of terminal bronchioles and distal airspaces

Chronic bronchitis = chronic mucus hypersecretion

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3
Q

What is emphysema?

A

Destruction of terminal bronchioles and distal airspaces

Loss of elastic tissue = lungs to hyperinflate

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4
Q

What is chronic bronchitis?

A

Chronic mucus hypersecretion

Inflam in large airways

Proliferation of goblet cells

Airflow obstruction due to remodelling

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5
Q

Describe the causes of COPD

A

Smoking (Most)

Alpha-1-antitrypsin deficiency (about 1%)

Occupational exposure e.g. coal dust

Pollution.

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6
Q

Describe the symptoms of COPD

A

Cough and sputum

Breathlessness

Exacerbations are associated with increased breathlessness and increased cough/sputum prod

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7
Q

Describe the signs of COPD

A

Sometimes no signs

Pursed lip breathing

Tachypnoea

Using accessory muscles

Hyperinflation

Cyanosis

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8
Q

What is the MRC dyspnoea score?

A

1) Not troubled by breathlessness except on strenuous exercise
2) Short of breath when hurrying or walking up a slight hill
3) Walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace
4) Stops for breath after walking about 100m or after a few minutes on level ground
5) Too breathless to leave the house, or breathless when dressing or undressing

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9
Q

Outline the investigation of COPD patients

A

Spirometry = forced expiratory manoeuvre

CXr = exclude other diagnoses

High-res CT = detailed assessment of macroscopic alveolar destruction

ABG = asses resp failure

Alpha-1-antitrypsin = younger pts

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10
Q

Outline the diagnosis of COPD

A

Suggestive symptoms/signs

FEV1 <80% predicted

FEV1/FVC ratio <70% = obstructive pattern

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11
Q

Outline the treatment of stable COPD

A

SMOKING CESSATION

Pulmonary Rehabilitation

Bronchodilators

Antimuscarinics

Steroids

Mucolytics

Diet – supplements / dietician review

Supportive e.g. flu vaccine

LONG TERM OXYGEN THERAPY if appropriate

LUNG VOLUME REDUCTION if appropriate

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12
Q

What drug therapies are available for stable COPD?

A

Bronchodilators

Steroids – inhaled

Antimuscarinics

Mucolytic

Methylxanthines

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13
Q

Outline the mechanism of action of beta-2 agonists

A

Ligand binds receptors = activates adenyl cyclase

Increasing cAMP and PKA

Phosphorylation of MLCK = relaxation of smooth muscle in airway = bronchodilation

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14
Q

Name a beta-2 agonist

A

Salbutamol

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15
Q

What are the adverse effects of B-2 agonists?

A

Tachycardia

Tremor

Anxiety

Palpitations

Hypokalaemia

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16
Q

Give an example of an anticholinergic

A

Ipratropium

17
Q

Outline the mechanism of an anticholinergic

A

Competitively inhibit binding of ACh

Can target muscarinic receptors and nAChR

18
Q

Outline the mechanism of methylxanthines

A

Inhibition of phosphodiesterases = no break down of cAMP = cAMP build up = bronchodilation

19
Q

What are the side effects of long-term steroid use?

A

Thin skin

Bruising

Cataracts

Adrenal insufficiency

Osteoporosis

Diabetes

Increased weight (fluid retention)

Mental disturbance

GI symptoms

Proximal myopathy

20
Q

What are mucolytics?

A

Help reduce thickness of sputum = help airway clearance

21
Q

What is deconditioning?

A

COPD pts avoid exercise because of breathlessness = increased social isolation = worsening symptoms = deconditioning

22
Q

Outline long term oxygen therapy (LTOT)

A

Continuous oxygen therapy for 16hrs/day

Must be non-smokers and not retain high CO2

23
Q

What are the surgical treatment options for COPD?

A

Lung volume reduction

Lung transplant

2.3.4. Respiratory System (19 decks)

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