COPD Flashcards
What is COPD?
Chronic obstructive pulmonary disease characterised by its irreversibility. Closely linked to smoking. Made up of chronic bronchitis and emphysema.
What is chronic bronchitis?
Cough with sputum production for at least 3 months in 2 consecutive years.
What is emphysema?
This encompasses permanently dilated airways distal to the terminal bronchioles with alveolar destruction and bullae formation. It is defined histologically and is associated with alpha-1 antitrypsin deficiency and increased elastase activity.
What are the causes of COPD?
Genetics: alpha-1 antitrypsin deficiency results in the loss of protection against proteases.
Air pollution.
Smoking.
Exposure through occupation, e.g. coal mining.
Secondhand smoke exposure.
What is the pathophysiology of chronic bronchitis?
Chronic infection results in the chronic infiltration of the respiratory submucosa by inflammatory cells. This results in mucous gland hyperplasia and smooth muscle hypertrophy, causing bronchial lumen narrowing. ‘Blue bloaters’ are patients where this pathology dominates.
What is the pathophysiology of emphysema?
Alveolar walls are destroyed resulting in bullae formation and the fusion of adjacent alveoli. This ultimately results in a decreased surface area for gas exchange and decreased elastic recoil with subsequent air trapping. ‘Pink puffers’ are patients where this pathology dominates.
What are the complications of COPD?
Cor pulmonale: right-sided heart failure due to chronic pulmonary hypertension.
Lung cancer.
Infections: usually treat with macrolide antibiotics.
Pneumothorax.
Polycythaemia.
Respiratory failure.
What investigations would you conduct for COPD?
Diagnosis is confirmed by spirometry, which has a FEV1 value <80% predicted and FEV1/FVC <0.7.
CXR shows lung hyperinflation, emphysematous change and diaphragmatic flattening.
Bloods: FBC, U&Es, WCC, ESR, CRP, alpha-1 antitrypsin levels.
ECG: for cor pulmonale.
Sputum culture.
What scale is used to assess the severity of COPD?
The GOLD scale. Stage I: mild COPD. Stage II: moderate COPD. Stage III: severe COPD. Stage IV: very severe COPD.
What is the treatment for COPD?
Anticholinergics, e.g. ipratropium. Bronchodilators, e.g. salmeterol. Corticosteroids. Smoking cessation is imperative. Oxygen therapy: long-term oxygen therapy (LTOT) or noninvasive ventilation (NIV).
