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COPD Flashcards

1
Q

How is COPD characterised?

A

Slowly progressive airflow obstruction that does not change markedly over months

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2
Q

How is the lumen occluded in COPD?

A

Secretion of mucous and inflammatory exudate

Wall thickening

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3
Q

What is the cause of COPD in the developing world?

A

Inhalation of biomass smoke

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4
Q

What percentage of COPD patients are diagnosed?

A

50%

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5
Q

Which portion of the population is most likely to suffer from COPD?

A

Basic education, low income males

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6
Q

How many deaths per year are due to COPD in the UK?

A

30,000

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7
Q

What percentage of care for COPD is exclusively in primary care?

A

88%

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8
Q

How many GP visits does a COPD patient have a year?

A

6-7

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9
Q

What impact does COPD have on the UK economy?

A

£1.7B pa

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10
Q

How much does COPD cost the NHS every year?

A

£819M

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11
Q

What percentage of COPD patients struggle to climb the stairs?

A

75%

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12
Q

What percentage of COPD is attributable to smoking?

A

85%

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13
Q

Other than smoking, what causes COPD?

A 
Chronic Asthma
Passive smoking
Maternal smoking
Air pollution
Occupation
a1-antitrypsin deficiency
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14
Q

What is the function of alpha1-antitrypsin?

A

Neutralising neutrophil enzymes (elastase)

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15
Q

What a1-AT mutation increases the risk of COPD?

A

PiZZ

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16
Q

What percentage of COPD patients have the PiZZ mutation?

A

1-2%

50% of severe COPD

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17
Q

What percentage of smokers develop airflow obstruction?

A

50%

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18
Q

What smoking history is usual in COPD patients?

A

> 20p/yr

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19
Q

What is the rate of decline of FEV1 in smokers?

A

50ml/yr

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20
Q

What is a typical patient for COPD?

A

40+
Smoker/ex smoker
Breathless on exertion
Cough

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21
Q

What is the DDx for a typical COPD patient

A 
COPD
Asthma
Lung cancer
LVF
Bronchiectasis
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22
Q

How does breathlessness present in COPD patients?

A 
Gradual onset
Little variation
Exacurbated by exercise
Housework/dress
AT REST
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23
Q

How does the cough present in COPD patients?

A

‘smokers cough’
Clear or mucoid
Early winter/all winter months

(95% resolution if quit smoking)

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24
Q

What are the symptoms of COPD?

A

Breathlessness
Cough+sputum
Recurrent Chest infections

Wheeze
Weight loss
Peripheral Oedema

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25
What is the cause of weight loss in COPD?
Cytokine release/TNFalpha
26
What causes peripheral oedema in COPD?
Cor pulmonale due to respiratory oedema causing right sided HF
27
Expected PMH of a COPD patient
Childhood asthma Respiratory diseases Ischaemic HD
28
Expected drug history
List of inhalers + dose | Steroids
29
Expected social history
Occupational (mining, farming, tunnels) Smoking history (how long, p/yr)
30
Signs of COPD
Breathless walking to clinic, pursed lips, accessory Cyanosis CO2 flap, tremor Steroid effects
31
Examination of COPD
``` Hyperexpanded chest Decreased expansion Paradoxical rib/abdomen movement Hyperresonant percussion Decreased breath sounds ```
32
Signs of Cor Pulmonale
``` Increased JVP Hepatomegaly Ascites Oedema RV heave ```
33
What are the essential investigations for COPD?
Full pulmonary function test Spirometry Reversibility to bronchodilators
34
Expected spirometry results in COPD?
FEV1/FVC <0.7 | FVC <80% expected
35
What are the different FEV1 categories for positive COPD spirometry results?
>80% Mild (at risk) 50-80% Moderate 30-50% Severe <30% very severe (cor pulmonale)
36
Expected Lung Volume test results
Increased residual volume Increased total lung capacity RV>TLC >30%
37
Expected CO gas transfer results
Decreased
38
Method of testing bronchodilator reversibility
15 minutes post nebulised Salbutamol | 30 minutes post neb Salb. + Ipratropium
39
What is a significant reversibility and what does it suggest?
change FEV1>200ml & change FEV1> 15% baseline | Suggests asthma
40
What other investigations would you use for COPD?
``` CXR Blood Gases (resp. failure) FBC (Secondary Polycythaemia) ECG Sputum culture ```
41
What would you see on a CXR of a COPD patient?
Hyperinflation (<10 ribs) Flattend Diaphragm Bullae Hyperlucence
42
What are the signs of respiratory failure?
``` Tachypnoea Cyanosis Use of Accessory muscles Pursed Lips Peripheral oedema ```
43
What investigation would you perform in a patient under 50?
a1-AT deficiency test
44
What are the aims of COPD management? | How would it be done?
``` Prevent progression (smoking cessation) Relieve breathlessness (Inhalers) > ICS and SABA Prevent exacerbation (vaccinations, pulmonary rehab) Manage complications (long term O2 therapy) ```
45
What short acting Bronchodilators are used in COPD?
SABA (Salbutamol) | SAMA (Ipratropium)
46
What long acting bronchodilators are used in COPD?
LAMA (Tioptropium) | LABA (Salmeterol)
47
What is the first inhaled treatment used for COPD?
SABA
48
What treatment follows SABA (single therapy)?
LAMA or LABA Then BOTH
49
What treatment follows LAMA, LABA and SABA therapy?
Triple therapy | ICS, LABA, LAMA
50
What PaO2 is normally used for Long Term Oxygen Therapy?
<7.3kPa
51
For what reasons would you use >7.3kPa LTOT? Up to what pressure?
Polycythaemia Noctournal hypoxia Peripheral Oedema Pulmonary Hypertension Up to 8kPa
52
How does AECOPD present?
``` Increasing Breathlessness Cough Sputum purulence/increased vol. Wheeze Chest tightness ```
53
What drug therapy would be used for AECOPD?
SABA (?nebuliser) Steroids (prednisolone) Antibiotics (if evidence of infection)
54
When would you admit a patient with AECOPD?
Tachypnoea <90% O2sat Hypotensive
55
Hospital investigations in a patient admitted for AECOPD
``` FBC, gluc ABG ECG CXR Blood/sputum culture Theophylline conc. (if using) ```
56
What is the ward target O2 sat for a patient with AECOPD?
88-92%
57
What would you do for an AECOPD patient in acute respiratory failure?
NIV
58
What would you check a ward patient for if they presented with AECOPD?
Respiratory failure
59
Antenatal factors in future COPD development
Nicotine Fetal/maternal infection Low birth weight Maternal malnutrition
60
Post-natal factors in COPD development
``` Infection Growth a1 AT Environmental pollution Micronutrients ```
61
What are the different forms of Emphysema?
CENTRIACINAR PANACINAR Periacinar Scar
62
What is the normal range of PEFR readings?
within 80-100% of best value
63
What is a moderate fail in PEFR readings?
50-80% of best value
64
What is a marked fail in PEFR readings?
<50% of best value
65
What type of hypersensitivity occurs in asthma?
Type 1 hypersensitivity
66
Clinical definition of chronic bronchitis
Productive cough of sputum in atleast 3 consecutive months for 2 or more consecutive years
67
What are the changes to the large airways that occur with chronic bronchitis?
Mucous gland hyperplasia Goblet cell hyperplasia Inflammation and fibrosis
68
What are the changes to the small airways that occur with chronic bronchitis?
Goblet cells appear | Inflammation and fibrosis
69
Clinical definition of Emphysema
Increase in airspaces distal to terminal bronchiole arising from dilation or from distruction of their walls WITHOUT FIBROSIS
70
What is panacinar emphysema?
Relatively uniform enlargement of air spaces throughout the terminal bronchioles and alveoli
71
What is centriacinar emphysema?
Enlargement of the airspaces in the proximal acinus
72
What is an acinus?
Region of the lung supplied by one terminal bronchiole
73
What is a bulla?
Emphasematous space >1cm
74
What is a bleb?
Emphasematoous space just beneath the pleura
75
How does smoking increase the risk COPD?
Decreased elastin synthesis Decreased anti-elastase Increased Neutrophils Increased elastase
76
How does hypoxia cause chronic Cor Pulmonale?
Hypertrophy of right ventricle resulting from disease affecting function/structure of the lung

Systems 1 (25 decks)

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