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Respiratory > COPD > Flashcards

COPD Flashcards

1
Q

Which 2 diseases make up COPD?

A

Chronic bronchitis and emphysema

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2
Q

What type of inflammation characterises Chronic bronchitis?

A

Neutrophilic

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3
Q

What are the consequences of chronic bronchitis?

A 
Chronic neutrophilic inflammation
Mucus hypersecretion
Mucocillary dysfunction
Altered lung microbiome 
Smooth muscle spasm and hypertrophy
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4
Q

Is chronic bronchitis reversible?

A

Partly

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5
Q

WHat happens to the lung microbiome in COPD?

A

More gram negative pattern

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6
Q

Is emphysema reversible?

A

No

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7
Q

What characterises emphysema?

A

Alveolar dysfunction
Impaired gas exchange
Loss of bronchial support

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8
Q

Outline the disease process in COPD.

A

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

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9
Q

What is released by alveolar macrophages to attract neutrophils?

A

Oxygen free radicals
IL8
LTB4

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10
Q

What is the cause of emphysema in non smokers?

A

Decrease in antiproteases

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11
Q

Common signs in a COPD history?

A 
Chronic symptoms getting progressively worse 
Smoker 
Non atopic
Daily productive cough 
Progressive SOB
Frequent infective exacerbations 
Wheeze
Reduced breath sounds in emphysema
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12
Q

What bacteria commonly causes infective exacerbations?

A

Haemophilous influenzae

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13
Q

What is cor pulmonale?

A

Pulmonary heart failure

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14
Q

How does cor pulmonale develop?

A

Impaired alveolar gas exchange => hypoxia => pulmonary vasoconstriction => increased pulmonary vascular resistance and pulmonary hypertension => right ventricular hypertrophy => cor pulmonale

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15
Q

What categorises the most high risk COPD patients?

A

FEV1 <50% of predicted

>2 exacerbations or 1 requiring hospital admission

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16
Q

What is ACOS?

A

Asthma COPD overlap syndrome

17
Q

What characterises ACOS?

A

COPD with blood eosinophilia of >4%

Steroid responsiveness and reversible with salbutamol to an extent

18
Q

Patients with COPD have a decreased FVC whereas in asthma FVC is conserved. True or false?

A

True

19
Q

Patients with COPD have impaired gas exchange whereas patients with asthma do not. True of false?

A

True

20
Q

How is an acute exacerbation of COPD treated in hospital?

A

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

21
Q

When would it be inappropriate to mechanically ventilate someone with COPD?

A

When there is NO reversible aspect to their exacerbation

22
Q

What are the symtoms of an exacerbation of COPD?

A 
Chronic sputum production, bronchoconstriction and inflammation of airways 
Preceded by and upper RTI
Increased sputum production
Increased sputum purulence
Increased wheeze 
Increased breathlessness
23
Q

What would you expect to find on examination of a patient with an acute exacerbation of COPD?

A 
Respiratory distress- accessory muscle use
Wheeze 
Course crackles 
maybe cyanosed
Ankle oedema in advanced disease
24
Q

How is an acute exacerbation of COPD treated in primary care and when would you refer to secondary care?

A

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

25
Q

Acute exacerbation of COPD is the most common cause of hospital admission in the UK. True or false?

A

True

26
Q

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?

A

Average stay = 3-7 days
1 year mortality = 30%
3 year mortality = 80%

Respiratory (26 decks)

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