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3.1 cards > COPD > Flashcards

COPD Flashcards

1
Q

5 main causes of airflow obstruction

A
  1. Bronchospasm (Asthma)
  2. Airway inflammation (Asthma, bronchitis)
  3. Mucous hyper-secretion (Bronchitis)
  4. External airway compression (Goitre)
  5. Dynamic airway collapse (loss of radial traction/increased lung compliance)
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2
Q

What is Carbon Monoxide transfer factor a measure of

A

Measure of integrity of alveolar-capillary membrane

Also called TLCO, DLCO, diffusing capacity

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3
Q

When is TLCO reduced

A
  1. Emphysema (due to loss of alveolar surface area)
  2. Interstitial lung disease (due to thickening of alveolar-capillary membrane) e.g. sarcoidosis, silicosis, asbestosis
  3. Pulmonary vascular disease (loss of vascular bed)
  4. Anaemia (reduction in available haemoglobin)
  5. Extra-pulmonary restriction (loss of lung volume)
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4
Q

What does a Plethysmography measure

A
  • FRC - functional residual capacity (air in lungs after passive expiration)
  • TLC - total lung capacity
  • RV - residual volumes- RV + expiatory residual volume = FRC
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5
Q

What component of the spirometry results should you use to detect obstruction

A

FEV1/FVC ratio compared to LLN

FEV1/FVC < LLN = obstruction

FER (forced expiratory ratio, just FEV1/FVC as a percentage) is low

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6
Q

What component of the spirometry result should you use to detect restriction

A

FVC compared to LLN

FVC or VC < LLN = restriction

FER (forced expiratory ratio, just FEV1/FVC as a percentage) is normal or high

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7
Q

Positive bronchodilator response

A

improvement of

  • > 200 ml or
  • > 12%

of baseline in FEV1 or FVC

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8
Q

Interpretating DLCO

A

Mild = >60% and

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9
Q

Interpretation of elevated PaCo2

A

Alveolar hypoventilation

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10
Q

Interpretation of elevated PaCO2

A

alveolar hyperventilation

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11
Q

Definition of COPD

A

irreversible airway obstruction FEV1/FVC <0.7

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12
Q

Subtypes of COPD

A

Most common

  1. emphysema
  2. chronic boncitis

less common

  1. asthma
  2. bronchiectasis (mucus hypersecretion following airway widening)
  3. cystic fibrosis
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13
Q

Role of alpha 1 - antitrypsin deficiency in COPD

A

Increases susceptibility to smoking resulting in COPD

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14
Q

Pathophysiology of Chronic Bronchitis

A

Lung inflammation –> injury to bronchial tress -

  1. Increased inflammatory cell e.g. neutrophil
  2. Goblet cell proliferation, –> Increase mucus production
  3. death of airway epitherlium, ciliated cells both

1 –> airway narrowing and fibrosis

2 and 3 –> muscus trapping

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15
Q

Pathophysiology of Emphysema

A

Lung inflammation –> proteolytic destruction of lung parenchyma -

  1. Decreases airway elasticity –> trapping of air in lung -
  2. Decreases structural supports for airway patency –> airway narrowing and collapse -
  3. Permanent enlargement of alveoli –> hyperinflated lungs and bullae (ruptured airsacs)
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16
Q

Signs of COPD

A
  • Hoover’s sign (paradoxial shrinking of lower chest during inspiration)
  • dyspnoea
  • Pursed lip breathing
  • Barrel chest
17
Q

CXR findings in COPD

A

Hyper inflated lungs

  • increase anteroposterior ratio,
  • flattened diaphragm,
  • increased intercostal space and
  • hyperlucent lungs
18
Q

What is the PaO2 in Hypoxemia

A

PaO2 <70 mmHg

19
Q

Whats is the PaCo2 in hypercapnia

A

PaCO2 >45 mmHg

20
Q

Lung function in mild, moderate and severe COPD

A
  • Mild 60-80 FEV1
  • Moderate 40-59 FEV1
  • Severe <40
21
Q

What are the four elements of pulmonary rehabilitation

A
  1. Exercise training
  2. Education
  3. behaviour modification
  4. outcome assessment
22
Q

Only mangement option known to improve SGRQ scores (respiration)

A

Pulmonary rehabilitation

23
Q

Non-pharmacological treatment of COPD

A
  • Smoking cesssation
  • Influenza vaccine annually, pneumococcal vaccine
  • Physical activity
  • Pulmonary rehabilitation
  • Nutrition review
  • Monitor co-morbidities - osteoporosis, coronary disease, lung cancer, anxiety, depression
24
Q

Phamacological therapy for COPD

A
  • Short acting bronchodilator therapy - reduce bronchoconstriction and air trapping - Salbutamol or tertutaline
  • Long acting bronchodilator therapy LABA or LAMA - Salmeterol or tiotropium
  • LABA + LAMA combo
  • ICS - reduces exacerbations
25
Q

Some complications of COPD

A
  1. Acute exacerbation
  2. Pneumonia
  3. Macro-nutrient dificiency
  4. Wasting/muscle atrophy
  5. Polycythemia
  6. Pulmonary hypertension
  7. Cor pulmonale
  8. Depression
  9. Pneumothorax
26
Q

Differentials for COPD

A
  1. Asthma - use response to bronchodilator to confirm
  2. Congestive Heart Failure - EEG to confirm
  3. Tuberculosis - Microbiology and CXR to confirm
  4. Pneumonia
  5. Pulmonary Odema - caused by CHF
  6. Acute respiratory distress syndrome
  7. Pulmonary vascular disease - pulmonary hypertension, thromboembolism and vasculities and malformations
  8. Diffuse interstitial disease - fibrosis
  9. Pneumoconiosis = dusty lungs
27
Q
A

3.1 cards (13 decks)

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