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BS - Respiratory System > COPD > Flashcards

COPD Flashcards

1
Q

What is COPD?

A

Chronic Obstructive Pulmonary Disorder

Damage due to chronic inflammation which is usually the result of tobacco smoke

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2
Q

What type of lung condition is COPD?

A

Obstructive

There is little or no reversibility in airflow obstruction

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3
Q

What is the main cause of COPD?

A

Smoking

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4
Q

How is it different to a smoker’s cough?

A

A smoker’s cough sees an improvement of symptoms in 90% of people when they stop smoking

COPD is not reversible

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5
Q

How many people in the UK have COPD?

A

3 million but only 1.2 million have been diagnosed

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6
Q

What % of people over 40 have COPD?

A

4.5%

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7
Q

What happens to the lungs in COPD?

A

They become inflamed, damaged and narrowed

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8
Q

What is chronic bronchitis?

A

Long-term inflammation of both the small and large airways

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9
Q

What is FEV1?

A

Forced expiratory volume in 1 second

The volume of air that can be expelled from maximum inspiration in the first second

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10
Q

What is FEV1 dependent on and what is it a reflection of?

A

Time dependent

Reflection of airway calibre

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11
Q

What is FVC?

A

Forced vital capacity of the lung

Volume of air that can be forcibly expelled from the lung from the maximum inspiration to the maximum expiration

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12
Q

What is FVC dependent on and what is it a reflection of?

A

Volume dependent

It does NOT reflect lung calibre, it reflects lung volume

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13
Q

How do FVC and FEV1 change in obstructive lung diseases?

A

FVC does not change as the volume of the lung is unchanged

FVC1 is reduced as less air can be expired in 1 second

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14
Q

What is the FEV1/FVC ratio in COPD?

A

It is reduced and less than 70%

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15
Q

How does COPD affect peak expiratory flow?

A

There is little variability

If variability is greater than 20%, this may be asthma

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16
Q

What are the symptoms of COPD?

A
  1. Dyspnoea
  2. Sputum production & purulence during exacerbations
  3. Cough
  4. Wheeze
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17
Q

What is dyspnoea?

A

Breathlessness

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18
Q

What is purulence?

A

Generation of large amounts of pus

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19
Q

What is an exacerbation?

A

acute increase in the severity of an illness

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20
Q

What are the 3 risk factors for COPD?

A
  1. smoking
  2. pollution
  3. alpha-1-antitrypsin deficiency

This is an autosomal recessive disorder

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21
Q

What is the role of alpha-1 antitrypsin?

A

It is a protease inhibitor which balances out the action of neutrophil elastase

Neutrophil elastase increases in response to inflammation, infection and smoking

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22
Q

What does neutrophil elastase do?

A

If unregulated, this enzyme disturbs the function of the lung permeability barrier and induces the release of pro-inflammatory cytokines

23
Q

In which group of people does COPD most commonly occur?

A

People over the age of 40 with a history of smoking

This can be tobacco or marijuana smoking

24
Q

How are pack years calculated?

A

multiplying the number of packs of cigarettes smoked daily by the number of years that the person has smoked

25
Q

How many pack years are equivalent to smoking 20 cigarettes a day for 1 year?

A

1 pack year

26
Q

What is emphysema?

A

A type of chronic obstructive pulmonary disease

27
Q

How does emphysema reduce the amount of oxygen in the bloodstream?

A

The surface area of the lungs is reduced

Damaged alveoli don’t work properly on expiration so old air becomes trapped, leaving no room for fresh oxygen-rich air to enter

28
Q

What happens in emphysema?

A

The alveoli are damaged as over time the inner walls of the air sacs weaken and rupture

Damage to the alveolar walls creates many larger air spaces instead of many smaller ones

29
Q

What are the main causes of emphysema?

A
  1. smoking
  2. deficiency of alpha-1 antitrypsin enzyme
  3. air pollution
  4. airway reactivity
  5. heredity
  6. male sex
  7. age
30
Q

What lung condition do people with emphysema often have?

A

chronic bronchitis

inflammation of the bronchial tubes which leads to a persistent cough

31
Q

What is the main symptom of emphysema?

A

People often have emphysema for many years without developing symptoms

It eventually causes shortness of breath, even when resting

32
Q

Why is ankle swelling seen in a COPD patient?

A

Due to the build up of fluid as the right heart struggles to pump due to a build-up of pressure in pulmonary circulation

33
Q

What can be a problem with oxygen therapy?

A

If there is a high blood pO2 - patients rely on hypoxic drive

34
Q

What is type 1 respiratory failure mostly associated with?

A

Hypoxia

PCO2 is normal as the reason this occurs is V/Q mismatch

35
Q

What is type 2 respiratory failure mostly associated with?

A

Hypoxia and hypocapnia due to inadequate ventilation

It is the actual ventilation of the alveoli which is failing

36
Q

What symptoms are associated with an exacerbation?

A

increased dyspnoea
increased sputum production
sputum becomes purulent and green
increased cough

37
Q

What do patients with COPD often look like physically?

A

Form a posture with pursed lips

They have lots of muscle wasting

CO2 flap is a flap of the hands associated with CO2 retention

38
Q

What are the types of oxygen therapy that are used?

A

Long term oxygen therapy

Ambulatory oxygen therapy

Short burst oxygen therapy

39
Q

What is involved in long term oxygen therapy?

A

using oxygen for at least 16 hours a day

40
Q

Why are patients usually started on long term oxygen therapy?

A

due to ankle swelling and low oxygen saturation

given to COPD patients with a pO2 less than 7.3 kPa

41
Q

What is the aim of long term oxygen therapy?

A

To reduce the strain on the heart and maintain oxygen saturation

42
Q

What is significant about LTOT in COPD patients?

A

It is the only treatment which can improve survival in COPD patients

43
Q

When is ambulatory oxygen therapy used?

A

Used during walking/exercise

Given to patients who have a significant drop in oxygen saturation when walking

44
Q

What is short burst oxygen therapy?

A

A short burst of oxygen is given just for relief

45
Q

How is the breathing process driven normally?

A

An increase in CO2 in the blood increases the breathing drive

46
Q

How is the breathing process driven in COPD patients?

A

There is a chronic increase in CO2 so the receptors for CO2 are no longer responsive

Low pO2 (hypoxaemia) triggers breathing instead

47
Q

What is a problem with giving patients too much oxygen?

A

Supplemental oxygen is given so the pO2 is constantly high and the hypoxic drive is not activated

Retention of additional CO2 leads to respiratory acidosis

48
Q

When are patients prescribed oxygen therapy?

A

If they have oxygen saturation of 94% or less

If they have a history of CO2 retention, oxygen saturation target is 88-92% to balance risk of hypoxia

49
Q

How does FEV1 demonstrate the severity of COPD?

A

The more FEV1 is reduced, the more severe the COPD is

50
Q

How could quitting smoking prevent COPD from becoming too severe?

A

The decline in FEV1 depends on when smokers quit smoking and their susceptibility to smoke

Quitting smoking earlier means FEV1 will not be reduced as much

51
Q

What are the criteria for prescribing oxygen therapy?

A

pO2 > 7.3 but < 8 kPa when stable and one of:

  1. secondary polycythaemia
  2. nocturnal hypoxaemia
  3. peripheral oedema
  4. pulmonary hypertension
52
Q

What are 3 therapies used to treat COPD?

A
  1. long term oxygen therapy
  2. pulmonary rehabilitation
  3. surgery - bullous disease
53
Q

What is pulmonary rehabilitation?

A

A programme specialised in breathing exercises to prevent worsening of symptoms in COPD patients

54
Q

What happens in bullous disease?

A

The parenchyma of the lung is completely destroyed

BS - Respiratory System (20 decks)

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