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Respiratory > COPD > Flashcards

COPD Flashcards

1
Q

What is the definition of COPD?

A

COPD is characterised by airflow obstruction… usually PROGRESSIVE, NOT fully REVERSIBLE and does NOT CHANGE markedly over several months. The disease is a CHRONIC INFLAMMATORY response in the airways and lungs to noxious particles or gases, predominantly caused by smoking

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2
Q

what is FEV1/FVC for airflow obstruction?

A

<0.7

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3
Q

what is the FEV1/FVC post bronchodilator?

A

still <0.7

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4
Q

what are the classifications of FEV1 is COPD?

A 
≥ 80% Stage 1 Mild*
50–79% Stage 2 – Moderate
30–49% Stage 3 – Severe
< 30% Stage 4 – Very severe
s0 severity is determined by FEV1
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5
Q

why is it harder to expel air in COPD?

A

the airways collapse as the elastic tissue is destroyed and the airways are no longer open, so there is high resistance against breathing out

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6
Q

what term d owe use to describe the flow volume loop shape for COPD is the expiratory part?

A

scolloped

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7
Q

what are the two mechanisms of airflow obstruction in COPD?

A

small airways disease

and parenchymal destruction

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8
Q

what are the characteristics of small airways disease in COPD?

A 
airway inflammation (inflammatory infiltrates) 
airway fibrosis (scarring of walls)  
luminal plugs (hyperplasia of glands and goblet cell metaplasia)
increased airway resistance
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9
Q

what are the parenchymal destruction aspects of COPD

A

loss of alveolar attachments

decrease of elastic recoil

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10
Q

what feature of COPD patients causes them to breath at a higher volume?

A

dynamic hyperinflation

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11
Q

Why do COPD pts show dynamic hyperinflation?

A

due to the scolloping of the flow volume curve, they can’t breathe their normal tidal breath at a normal volume, need to do this at a higher volume. So inflate their lungs to breathe. when they do exercise, they have to breathe at even higher lung volumes

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12
Q

what is the V/Q match like in COPD

A

mismatch

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13
Q

would the values for Tlco and Kco be high or low?

A

low

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14
Q

is a high pCO2 seen in COPD?

A

potentially, but remember there is type 1 and type 2 resp failure and so this would mean type 2 resp failure. poor ventilation can give high pCO2

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15
Q

Is pulmonary hypertension seen and why?

A

yes as the alveoli are obliterated, so there is less oxygenation and hypoxaemia results, so the blood vessels constrict to reduce the V/Q mismatch

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16
Q

what are the signs and symptoms of COPD?

A 
Shortage of breath
Cough, phlegm
Wheeze
Raised respiratory rate
Hyperexpansion/barel shaped chest
Cyanosis
Weight loss
‘cor pulmonale’
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17
Q

who are the pt groups most likely to get COPD?

A

Old patients, smokers, male predominance

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18
Q

what are the features of a pink puffer?

A

breathlessness is the predominant problem - they are not cyanosed
weight loss
pursed lips on expiration help to prevent airway collapse

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19
Q

what are the features of blue bloaters?

A 
hypoventilation
productive cough 
cpr pulmonale 
peripheral oedema 
barrel chest 
features of CO2 retention, bounding pulse, warm peripheries, flapping tremor of outstretched hands and maybe confusion
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20
Q

what are the risk factors for COPD?

A 
smoking + passive
occupational dust and chemicals 
pollution
genes - alpha 1 antitrypsin deficiency  
infections 
socio-economic status 
age
illicit drug smoking
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21
Q

what are the points of the MRC (Medical Research Council) dyspnoea scale?

A

grade 1: SOB on strenuous exercise
grade 2: SOB hurrying on level or walking up slight hill
grade 3: Walks slower than most people on the level, stops after a mile or so, or stops after 15 minutes walking at own pace
grade 4: Stops for breath after walking 100 yards, or after a few minutes on level ground
grade 5: Too breathless to leave the house, or breathless when dressing/undressing

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22
Q

what are the points covered by the COPD assessment score (CAT)?

A 
Cough
Phlegm
Chest tightness
Breathlessness going up hills/stairs
Activity limitation at home
Confidence leaving the home
Sleep and energy 
final score (minimum 0, maximum 40) – this is a measure of the overall impact of a patient’s condition on their life.
23
Q

is lung function a strong predictor of QOL?

A

no - other factors play a role in QOL

24
Q

what other treatment option is there apart from drug therapy to help reduce decline?

A

exercise therapy

25
Q

what are the differential diagnoses of COPD?

A 
Other causes of SOB
Congestive Heart failure
Pulmonary embolus
Pneumonia
Lung cancer
Asthma
Broncheictasis
TB
allergic fibrosing alveolitis
26
Q

what is the reversibility of asthma compared to COPD as a percentage?

A

<15% for COPD

>20% for asthma

27
Q

what features in pathology are more pronounced in COPD than asthma?

A

more fibrosis

alveolar disruption

28
Q

what features in pathology are more pronounced in asthma than COPD?

A

arterial smooth muscle is more pronounced in asthma and the BM is thicker in asthma

29
Q

which inflammatory cells predominate in asthma?

A

mast cells
eosinophils
CD4 T cells
macrophages

30
Q

which inflammatory cells predominate in COPD?

A

neutrophils (think about the alveoli that are destroyed)
CD8 T cells
macrophages (think about the material they need to phagocytose from the atmosphere)

31
Q

which condition has a greater response to steroids - asthma or COPD?

A

asthma - COPD is difficult to treat

32
Q

does COPD affect all airways or just peripheral ones?

A

peripheral - it is a small airways disease

33
Q

what mediators are involved in asthma ?

A

leukotrienes
histamine
IL-4, IL-5
some ROS

34
Q

what mediators are involved in COPD?

A

leukotrienes
IL-8, TNF alpha
ROS

35
Q

five examples of co-morbidities seen in COPD pts

A

Cardiac disease, cancer, renal failure, diabetes, weight loss, depression, anxiety, osteoporosis

36
Q

what are the therapeutic options for COPD?

A

smoking cessation
pharmacotherapy
nicotine replacement
pulmonary rehab and regular physical activity
flu vaccine and pneumococcal vaccine (against Strep pneumoniae)
oxygen therapy and NIV (non-invasive ventilation)

37
Q

what is pulmonary rehab?

A

exercise training programmes
usually 6 weeks long
exercise encouraged to be maintained at home after the programme

38
Q

what are the problems with COPD medication?

A

None of the existing medications for COPD has been shown conclusively to modify the long-term decline in lung function

39
Q

what two things do we want to get out of management of COPD?

A 
reduce symptoms 
reduce risk (prevent disease progression, prevent and treat exacerbations, reduce mortality)
40
Q

what are the principal bronchodilators used for COPD?

A

beta2- agonists, anticholinergics, theophylline

41
Q

why are long acting inhaled bronchodilators more effective for COPD?

A

as COPD symptoms are progressive and not variable and are better at preventing flare-ups and reducing exacerbations

42
Q

what are the advantages of inhaled CS in COPD pts?

A

improved symptoms, lung function and quality of life

reduces frequency of exacerbations

43
Q

what are the disadvantages of ICS in COPD?

A

associated with an increased risk of pneumonia

withdrawal may lead to exacerbations

44
Q

what factor can be used to predict success with ICS in COPD pts?

A

sputum eosinophil count: An increased sputum eosinophil count is related to an improvement in post-bronchodilator FEV1 following treatment with ICS in COPD

45
Q

what is combination therapy in COPD?

A

ICS with a long-acting beta 2 agonist

a long acting anticholinergic like tiotropium can also be added to this to increase efficacy further

46
Q

are oral steroids advised in COPD?

A

no - for long term treatment, they should be avoided as there are too many side effects to justify using them

47
Q

what is an exacerbation of COPD?

A

an acute event characterised by a worsening of the patient’s respiratory symptoms that is beyond normal day-to-day variations and leads to a change in medication

48
Q

what are the consequences of COPD exacerbations?

A 
reduced QOL
worsening of symptoms and reduced lung function
increased economic costs 
increased mortality 
accelerated lung function decline
49
Q

how are exacerbations managed?

A

diagnosis relies on the pt complaining of an acute change in symptoms beyond normal day-day variation
need to give more bronchodilators (short acting beta 2 agonists and short acting anticholinergics are preferred) at higher doses
give antibiotics if purulent sputum
ICS

50
Q

What investigations are needed if a COPD pt has an exacerbation?

A

ABGs
CXR - to exclude other diagnoses eg pneumothorax, PE
ECG - help to diagnose cardiac problems, eg heart failure
whole blood count - to identify polycythaemia, anaemia or bleeding
sputum sample
biochem tests - for electrolyte disturbances

51
Q

what are the criteria for giving antibiotics in an exacerbation?

A

increased dyspnea, increased sputum volume, and increased sputum purulence
those who require mechanical ventilation

52
Q

what are the indications for hospital admission for COPD?

A 
marked increase in intensity of symptoms 
Severe underlying COPD
Onset of new physical signs 
Failure of an exacerbation to respond to initial medical management
Presence of serious comorbidities
Frequent exacerbations
Older age
Insufficient home support
53
Q

what are the features of increased inflammation in COPD?

A 
increased neutrophils 
increased macrophages 
increased cytokines
increased mediators 
increased proteases

Respiratory (12 decks)

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