COPD Flashcards
define COPD
progressive disease characterised by airflow limitation that can potentially be reversed
causes of COPD
- smoking
- abnormal inflammatory response to noxious particles
pathological changes in COPD
- increased mucous secreting cells
- inflammatory cells in bronchi
- scarring and thickening of small airways
- loss of recoil (emphysema)
describe emphysema
permanent enlargement of airspaces/alveoli distal to the terminal bronchioles
what does alveoli dilatation in emphysema cause?
expiratory airflow limitation
are patients with emphysema the pink puffers?
yes
explain the pink puffers
- very thin with a barrel chest
- little or no cough
- pursed lips
- use of accessory respiratory muscles
- hyper resonant
- wheezing
how does hyperinflation of the lungs occur in emphysema?
loss of elasticity and mucus secretion leads to air trapping
how is V/Q mismatch produced in emphysema?
inflammation and scarring
describe chronic bronchitis
increased mucus secretion
physiology of chronic bronchitis
- low alveolar ventilation (cyanosed, but not SOB)
- low PaO2 and high PaCO2
- rely on hypoxic drive
clinical features
- productive cough (white or clear sputum)
- wheeze
- breathlessness
- frequent infections
what can occur in the later stages of COPD
respiratory failure due to chronic alveolar hypoxia and hypercapnia
investigations into COPD
- clinical examination/ history
- spirometry
- PEFR
- CXR
- blood gases
characteristic spirometry result
reduced FEV1
reduced FEV1/FVC
PEFR in COPD
reduced
CXR in COPD
hyperinflation with a flattened diaphragm
blood gases in COPD
normally normal but can get hypercapnia
non-pharmacological treatment for COPD
smoking cessation
pharmacological treatment of COPD
- SABA/SAMA (salbutamol or ipratropium)
=2 if FEV1 more than 50% then LABA or LAMA (salmeterol or tiotroprium)
=2 if FEV1 less than 50% than LABA + ICS - LABA + ICS + LAMA
are chronic bronchitis patients the blue bloaters?
yes
features of the blue bloaters
- may be obese
- Frequent cough
- Use of accessory muscles
- wheezing
- may have signs of right heart failure (cor pulmonale), such as oedema and cyanosis
how does chronic bronchitis cause pulmonary hypertension (cor pulmonale)
fluid retention and peripheral oedema due to failure of sodium excretion
