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Respiratory system > COPD > Flashcards

COPD Flashcards

1
Q

What is chronic obstructive pulmonary disease (COPD)?

A

Long-term airflow obstruction

that is progressive

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2
Q

What are the main types of COPD?

A

Emphysema

Chronic bronchitis

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3
Q

What is emphysema?

A

Destruction of terminal bronchioles, respiratory bronchioles and alveolar walls

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4
Q

How does emphysema affect the respiratory membrane?

A

Loss of surface area of respiratory membrane

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5
Q

How does emphysema affect gas exchange in the alveoli?

A

Reduced gas exchange

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6
Q

How does emphysema affect the air spaces in the lungs?

A

Large airspaces called bullae

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7
Q

How does emphysema affect expiration?

A

Reduced expiration

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8
Q

Why does emphysema cause reduced expiration?

A

Because loss of elastin in alveolar walls
don’t hold terminal bronchioles open
which collapse more easily during expiration

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9
Q

How does emphysema affect the size of the lungs?

A

Hyper-inflation of lungs

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10
Q

Why does emphysema cause hyper-inflation of lungs?

A

Less air expired in last breath
more air inspired on top of this

Loss of elastic recoil, lungs are more compliant, bigger increase in volume with same change in pleural pressure

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11
Q

What is chronic bronchitis?

A

Chronic mucus hypersecretion

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12
Q

What causes mucus hypersecretion with chronic bronchitis?

A

Inflammation in bronchi

gives mucous gland hyperplasia

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13
Q

How does chronic bronchitis affect the airways?

A

Narrowing of airways

due to mucus

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14
Q

What is a complication of the mucus hypersecretion in chronic bronchitis?

A

Traps bacteria

frequent respiratory infections

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15
Q

What are the causes of COPD?

A

Mostly smoking

Alpha-1-antitrypsin deficiency

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16
Q

What relative proportion of smokers get COPD?

A

Small proportion

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17
Q

What are the symptoms of COPD?

A

Cough with sputum

Breathlessness on exertion

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18
Q

What are the signs of COPD?

A

Purse lip breathing

Tachypnoea

Using accessory muscles

Barrel chest

Wheeze on auscultation

Cyanosis

High pCO2

Right-sided heart failure

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19
Q

Why do patients with COPD show purse lip breathing?

A

Increases pressure in airways

to delay collapse of small bronchioles

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20
Q

Why do patients with COPD use accessory muscles?

A

Because the lungs have less elastic recoil

so need to use internal intercostal muscles, abdominal muscles in order to reduce their volume

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21
Q

Why are patients with COPD barrel-chested?

A

Hyper-inflation of lungs

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22
Q

Why do patients with COPD have cyanosis, high pCO2?

A

Reduced gas exchange
gives hypoxaemia, cyanosis
and high pCO2

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23
Q

Why do patients with COPD get right-sided heart failure?

A

In response to low pO2 in alveoli
get hypoxic pulmonary vasoconstriction
increases pulmonary vascular resistance
increases pressure in right side of heart

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24
Q

How is COPD diagosed?

A

History of symptoms and signs

Spirometry

Chest X ray

High resolution CT

Arterial blood gases

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25
Q

What would spirometry of a patient with COPD show?

A

Low FEV1

Low FEV1/FVC ratio

How low they each are, correlating with severity

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26
Q

What would a chest X-ray of a patient with COPD show?

A

Hyper-inflation of lungs

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27
Q

What would a high resolution CT of a patient with COPD show?

A

Degree of terminal bronchiole, respiratory bronchiole and alveolar wall destruction

28
Q

What would arterial blood gases of a patient with COPD show?

A

Type 2 respiratory failure

  • low plasma pO2
  • high plasma pCO2

Maybe respiratory acidosis
-low plasma pH

29
Q

What is meant by stable COPD?

A

Patient has COPD but is able to manage at home

30
Q

How are patients with stable COPD managed?

A

Stop smoking

Pulmonary rehabilitation

Drugs

Flu vaccinations

Long term oxygen therapy

Lung volume reduction

31
Q

How does FEV1 change with age?

A

After a certain age, decreases

32
Q

How does smoking affect the decrease in FEV1 with age?

A

Faster rate of decrease in FEV1

33
Q

Why are patients with stable COPD advised to stop smoking?

A

Reduces rate of decrease in FEV1

regardless of how long have been smoking, regardless of age when stop smoking

34
Q

What is meant by deconditioning of a patient with COPD?

A

Exercise makes them feel breathless
they avoid exercise
their muscles weaken
they got more breathless

35
Q

What is pulmonary rehabilitation?

A

Encourages patients with COPD to exercise, improve their diet
to stop deconditioning

36
Q

What drugs are used to treat a patient with COPD?

A

B2 agonist

Steroids

Antimuscarinics

Mucolytics

Matylxanthines

37
Q

How do B2 agonists treat a patient with COPD?

A

Cause bronchodilation

38
Q

What are the side effects of using a B2 agonist to treat a patient with COPD?

A

Tachycardia, palpitations

Tremors

39
Q

Why can B2 agonists cause tachycardia, palpitations?

A

Act on B1 adrenoceptors in the heart

activate them

40
Q

Why can B2 agonists cause tremors?

A

Act on B2 adrenoceptors in skeletal muscle

activate them

41
Q

How do anticholinergics treat a patient with COPD?

A

Antagonise M3 receptors in the bronchi

preventing bronchoconstriction

42
Q

What are the side of effects of using anticholingerics to treat a patient with COPD?

A

Dry mouth

Supraventricular tachycardia

Urinary retention

43
Q

Why can anticholinergics cause a dry mouth?

A

Block muscarinic receptors in the salivary glands

loss of parasympathetic stimulation to make them secrete

44
Q

What can anticholingerics cause a supraventricular tachycardia?

A

Block M2 receptors in the AV node

loss of parasympathetic stimulation to decrease heart rate

45
Q

Why can anticholinergics cause urinary retention?

A

Block M3 receptors in the bladder detrusor muscle

loss of parasympathetic stimulation to make it contract and expel urine

46
Q

How do methylxanthines treat a patient with COPD?

A

Bronchodilation

Anti-inflammatory

47
Q

How do methylxanthines cause bronchodilation?

A

Inhibit phosphodiesterase
which breaks down cAMP

Less cAMP broken down
more cAMP present

48
Q

What are the side effects of methylxanthines?

A

Nausea

Supraventricular tachycardia

Headaches, seizures

49
Q

What is an example of a methylxanthine?

A

Aminophylline

50
Q

When do long-term steroids cause side effects?

A

High dose of inhaled steroids

Oral steroids

51
Q

What are the side effects of long-term steroids?

A

Thin skin, bruising

Adrenal insufficiency

Fluid retention

52
Q

How do mucolytics treat a patient with COPD?

A

Reduce thickness of mucus in airways

making it easier to clear

53
Q

What is an example of a mucolytic?

A

Carbocysteine

54
Q

How does long-term oxygen therapy treat a patient with COPD?

A

Prevents damage by hypoxaemia to organs e.g. heart, kidneys

55
Q

Why are patients with COPD particularly given flu vaccinations?

A

To prevent acute exacerbations of COPD

caused by infection

56
Q

When is long-term oxygen therapy used to treat a patient with COPD?

A

Persistent hypoxaemia

Cor pulmonale

57
Q

What are the side effects of long-term oxygen therapy?

A

High plasma pCO2

58
Q

Why does long-term oxygen therapy cause high plasma pCO2?

A

Loss of stimulation to peripheral chemoreceptors
don’t stimulate increased ventilation
ventilation decreases

59
Q

When is lung volume reduction surgery used to treat a patient with COPD?

A

When emphysema only affects upper lobes

60
Q

How does long volume reduction surgery treat a patient with COPD?

A

Reduces large air spaces, bullae, less dead space

61
Q

What is an acute exacerbation of COPD?

A

Temporary worsening of symptoms

  • cough with sputum
  • breathlessness on exertion

Type 2 respiratory failure, respiratory acidosis

62
Q

What causes an acute exacerbation of COPD?

A

Infection

63
Q

How is an acute exacerbation of COPD treated?

A

Controlled oxygen therapy

Nebulised bronchodilators

Oral or IV steroids

Antibiotics if have infection

In don’t improve, non-invasive ventilation, invasive ventilation

64
Q

What is non-invasive ventilation?

A

Ventilatory support through patient’s upper airway

using a facial mask

65
Q

When should non-invasive ventilation not be used to treat a patient with an acute exacerbation of COPD?

A

Untreated pneumothroax

Impaired concsciousness

Upper airway secreions

Facial injury

Vomiting

Respiratory system (32 decks)

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