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Systems 1 > COPD > Flashcards

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
Q

What is the cause of weight loss in COPD?

A

Cytokine release/TNFalpha

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26
Q

What causes peripheral oedema in COPD?

A

Cor pulmonale due to respiratory oedema causing right sided HF

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27
Q

Expected PMH of a COPD patient

A

Childhood asthma
Respiratory diseases
Ischaemic HD

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28
Q

Expected drug history

A

List of inhalers + dose

Steroids

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29
Q

Expected social history

A

Occupational
(mining, farming, tunnels)
Smoking history
(how long, p/yr)

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30
Q

Signs of COPD

A

Breathless walking to clinic, pursed lips, accessory
Cyanosis
CO2 flap, tremor
Steroid effects

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31
Q

Examination of COPD

A 
Hyperexpanded chest
Decreased expansion
Paradoxical rib/abdomen movement 
Hyperresonant percussion
Decreased breath sounds
32
Q

Signs of Cor Pulmonale

A 
Increased JVP
Hepatomegaly
Ascites
Oedema
RV heave
33
Q

What are the essential investigations for COPD?

A

Full pulmonary function test
Spirometry
Reversibility to bronchodilators

34
Q

Expected spirometry results in COPD?

A

FEV1/FVC <0.7

FVC <80% expected

35
Q

What are the different FEV1 categories for positive COPD spirometry results?

A

> 80% Mild (at risk)
50-80% Moderate
30-50% Severe
<30% very severe (cor pulmonale)

36
Q

Expected Lung Volume test results

A

Increased residual volume
Increased total lung capacity
RV>TLC >30%

37
Q

Expected CO gas transfer results

A

Decreased

38
Q

Method of testing bronchodilator reversibility

A

15 minutes post nebulised Salbutamol

30 minutes post neb Salb. + Ipratropium

39
Q

What is a significant reversibility and what does it suggest?

A

change FEV1>200ml & change FEV1> 15% baseline

Suggests asthma

40
Q

What other investigations would you use for COPD?

A 
CXR 
Blood Gases (resp. failure)
FBC (Secondary Polycythaemia)
ECG
Sputum culture
41
Q

What would you see on a CXR of a COPD patient?

A

Hyperinflation (<10 ribs)
Flattend Diaphragm
Bullae
Hyperlucence

42
Q

What are the signs of respiratory failure?

A 
Tachypnoea
Cyanosis
Use of Accessory muscles
Pursed Lips
Peripheral oedema
43
Q

What investigation would you perform in a patient under 50?

A

a1-AT deficiency test

44
Q

What are the aims of COPD management?

How would it be done?

A 
Prevent progression
(smoking cessation)
Relieve breathlessness
(Inhalers) > ICS and SABA
Prevent exacerbation 
(vaccinations, pulmonary rehab)
Manage complications
(long term O2 therapy)
45
Q

What short acting Bronchodilators are used in COPD?

A

SABA (Salbutamol)

SAMA (Ipratropium)

46
Q

What long acting bronchodilators are used in COPD?

A

LAMA (Tioptropium)

LABA (Salmeterol)

47
Q

What is the first inhaled treatment used for COPD?

A

SABA

48
Q

What treatment follows SABA (single therapy)?

A

LAMA or LABA

Then BOTH

49
Q

What treatment follows LAMA, LABA and SABA therapy?

A

Triple therapy

ICS, LABA, LAMA

50
Q

What PaO2 is normally used for Long Term Oxygen Therapy?

A

<7.3kPa

51
Q

For what reasons would you use >7.3kPa LTOT? Up to what pressure?

A

Polycythaemia
Noctournal hypoxia
Peripheral Oedema
Pulmonary Hypertension

Up to 8kPa

52
Q

How does AECOPD present?

A 
Increasing Breathlessness
Cough
Sputum purulence/increased vol.
Wheeze
Chest tightness
53
Q

What drug therapy would be used for AECOPD?

A

SABA (?nebuliser)
Steroids (prednisolone)

Antibiotics (if evidence of infection)

54
Q

When would you admit a patient with AECOPD?

A

Tachypnoea
<90% O2sat
Hypotensive

55
Q

Hospital investigations in a patient admitted for AECOPD

A 
FBC, gluc
ABG
ECG
CXR
Blood/sputum culture
Theophylline conc. (if using)
56
Q

What is the ward target O2 sat for a patient with AECOPD?

A

88-92%

57
Q

What would you do for an AECOPD patient in acute respiratory failure?

A

NIV

58
Q

What would you check a ward patient for if they presented with AECOPD?

A

Respiratory failure

59
Q

Antenatal factors in future COPD development

A

Nicotine
Fetal/maternal infection
Low birth weight
Maternal malnutrition

60
Q

Post-natal factors in COPD development

A 
Infection
Growth
a1 AT
Environmental pollution
Micronutrients
61
Q

What are the different forms of Emphysema?

A

CENTRIACINAR
PANACINAR
Periacinar
Scar

62
Q

What is the normal range of PEFR readings?

A

within 80-100% of best value

63
Q

What is a moderate fail in PEFR readings?

A

50-80% of best value

64
Q

What is a marked fail in PEFR readings?

A

<50% of best value

65
Q

What type of hypersensitivity occurs in asthma?

A

Type 1 hypersensitivity

66
Q

Clinical definition of chronic bronchitis

A

Productive cough of sputum in atleast 3 consecutive months for 2 or more consecutive years

67
Q

What are the changes to the large airways that occur with chronic bronchitis?

A

Mucous gland hyperplasia
Goblet cell hyperplasia
Inflammation and fibrosis

68
Q

What are the changes to the small airways that occur with chronic bronchitis?

A

Goblet cells appear

Inflammation and fibrosis

69
Q

Clinical definition of Emphysema

A

Increase in airspaces distal to terminal bronchiole arising from dilation or from distruction of their walls WITHOUT FIBROSIS

70
Q

What is panacinar emphysema?

A

Relatively uniform enlargement of air spaces throughout the terminal bronchioles and alveoli

71
Q

What is centriacinar emphysema?

A

Enlargement of the airspaces in the proximal acinus

72
Q

What is an acinus?

A

Region of the lung supplied by one terminal bronchiole

73
Q

What is a bulla?

A

Emphasematous space >1cm

74
Q

What is a bleb?

A

Emphasematoous space just beneath the pleura

75
Q

How does smoking increase the risk COPD?

A

Decreased elastin synthesis
Decreased anti-elastase
Increased Neutrophils
Increased elastase

76
Q

How does hypoxia cause chronic Cor Pulmonale?

A

Hypertrophy of right ventricle resulting from disease affecting function/structure of the lung

Systems 1 (25 decks)

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