COPD Flashcards
Which 2 diseases make up COPD?
Chronic bronchitis and emphysema
What type of inflammation characterises Chronic bronchitis?
Neutrophilic
What are the consequences of chronic bronchitis?
Chronic neutrophilic inflammation Mucus hypersecretion Mucocillary dysfunction Altered lung microbiome Smooth muscle spasm and hypertrophy
Is chronic bronchitis reversible?
Partly
WHat happens to the lung microbiome in COPD?
More gram negative pattern
Is emphysema reversible?
No
What characterises emphysema?
Alveolar dysfunction
Impaired gas exchange
Loss of bronchial support
Outline the disease process in COPD.
1) Cigarrette smoke leads to alveolar macrophages engulfing debris
2) Macrophage releases oxygen free radicals, IL8 and mediator LTB4 which are chemotaxins attracting neutrophils
3) Neutrophils cause an increase in proteases which leads to alveolar wall destruction (emphysema) and mucus hypersecretion (chronic bronchitis)
4) Progressive airway obstruction
What is released by alveolar macrophages to attract neutrophils?
Oxygen free radicals
IL8
LTB4
What is the cause of emphysema in non smokers?
Decrease in antiproteases
Common signs in a COPD history?
Chronic symptoms getting progressively worse Smoker Non atopic Daily productive cough Progressive SOB Frequent infective exacerbations Wheeze Reduced breath sounds in emphysema
What bacteria commonly causes infective exacerbations?
Haemophilous influenzae
What is cor pulmonale?
Pulmonary heart failure
How does cor pulmonale develop?
Impaired alveolar gas exchange => hypoxia => pulmonary vasoconstriction => increased pulmonary vascular resistance and pulmonary hypertension => right ventricular hypertrophy => cor pulmonale
What categorises the most high risk COPD patients?
FEV1 <50% of predicted
>2 exacerbations or 1 requiring hospital admission
What is ACOS?
Asthma COPD overlap syndrome
What characterises ACOS?
COPD with blood eosinophilia of >4%
Steroid responsiveness and reversible with salbutamol to an extent
Patients with COPD have a decreased FVC whereas in asthma FVC is conserved. True or false?
True
Patients with COPD have impaired gas exchange whereas patients with asthma do not. True of false?
True
How is an acute exacerbation of COPD treated in hospital?
1) Nebulised salbutamol and ipratropium
2) Oral prednisalone (5 days)
3) Antibiotic if infection
4) Oxygen 24-28%- ABGs for type 2 respiratory failure
5) Physio to assist with sputum expectoration
6) CXR to rule out other disease
When would it be inappropriate to mechanically ventilate someone with COPD?
When there is NO reversible aspect to their exacerbation
What are the symtoms of an exacerbation of COPD?
Chronic sputum production, bronchoconstriction and inflammation of airways Preceded by and upper RTI Increased sputum production Increased sputum purulence Increased wheeze Increased breathlessness
What would you expect to find on examination of a patient with an acute exacerbation of COPD?
Respiratory distress- accessory muscle use Wheeze Course crackles maybe cyanosed Ankle oedema in advanced disease
How is an acute exacerbation of COPD treated in primary care and when would you refer to secondary care?
1) Salbutamol inhaler
2) Oral prednisalone (5 days)
3) Antibiotic (usually penicillin or amoxacillin)
Refer to secondary care if there is evidence of respiratory failure or they are not coping at home
Acute exacerbation of COPD is the most common cause of hospital admission in the UK. True or false?
True
What is the average length of hospital stay for someone with an acute exacerbation of COPD and what is there 1 year and 3 year mortality?
Average stay = 3-7 days
1 year mortality = 30%
3 year mortality = 80%
