COPD Flashcards
Define COPD
An umbrella term used to describe progressive pulmonary diseases including emphysema, chronic bronchitis and irreversible asthma. It is a disease characterised by progressive airflow limitation that is irreversible. This makes breathing very difficult
What is emphysema?
condition that damages lung tissue and traps air
Describe emphysema
Breakdown of elastin causes loss of elasticity/recoil and loss of shape of alveoli.
This causes air to be trapped and narrowing/collapse of small airways.
Damage to alveolar membranes
This causes pulmonary hyperinflation and a barrel chest. Expiration is difficult and lungs cannot empty efficiently.
PINK PUFFERS
What is chronic bronchitis?
Inflammation of the bronchial airways
Describe chronic bronchitis
Increase in mucus production due to enlarged mucus glands and increase in goblet cells which can obstruct the airways.
Dysfunction of cilia hairs results in build-up of mucus which narrows airways and makes it difficult to breathe.
This leads to productive cough and wheezing.
There is alveolar hypoxia which causes vasoconstriction of pulmonary capillaries and a pulmonary shunt so that blood can be redirected to healthy alveoli.
what is irreversible asthma?
Chronic inflammatory disorder of the airways. Becomes irreversible as medication cannot reverse the effects.
causes of COPD?
Environmental:
pollutants e.g. cigarette smoke, pollution
Genetic:
alpha-1 antitrypsin deficiency makes people more sensitive to cigarette smoke and pollution
what are symptoms of COPD?
Chronic productive cough Breathlessness doing daily activities Frequent respiratory infections Cyanosis on fingernails or lips Fatigue Excess mucus production Chest tightness Wheezing
What is the function alpha1 antitrypsin ?
It is an enzyme inhibitor which inhibits the protease, neutrophil elastase
What is the pathophysiology of COPD?
Increase in goblet cells and hypertrophy of mucus glands = increased mucus production
Cilia hair dysfunction
Squamous cell metaplasia = change from columnar epithelium to squamous
Infiltration of the bronchial walls with inflammatory cells:
Increase in alveolar macrophages
Lymphocyte infiltration: CD8 T cells and neutrophils which produce neutrophil elastase, a protease, that breaks down elastin = loss of elasticity and recoil.
Inflammation is replaced by thickening and scarring of walls = fibrosis of bronchial walls
Increased smooth muscle in small airways
Describe the drug treatments recommended for COPD management
Bronchodilators:
Beta 2 agonists e.g, salbutamol (SABA) can help with breathlessness, if COPD is more severe then LABA inhalers can be used e.g. salmeterol.
Anti Muscarinic drugs: these are anti-cholinergic drugs. They achieve longer and more prolonged bronchodilation.
Oral theophyllines: These are a type of Xanthine. However they have multiple drug interactions so much be used carefully.
Oral corticosteroids: e.g. prednisolone, aren’t usually recommended except for acute exacerbations of COPD. Dosage should be kept low as there is a risk of osteoporosis.
Oral mucolytic drugs can reduce the stickiness of mucus, enabling it to be coughed up more easily.
Antibiotics: should only be given in acute episode of COPD and to shorten exacerbations.
Give two examples of oral mucolytic drugs
Carbocysteine and erdosteine
Describe the alternative treatments for the management of COPD
Smoking cessation
Diuretic therapy: for oedematous patients
Oxygen therapy : given to patents at home to relieve symptoms
Pulmonary rehabilitation programme: gives patients a programme of targeted exercises and education
Influenza and pneumococcal pneumonia vaccination
In very rare cases, surgery or lung transplants will be considered.
What are the symptoms of COPD and Asthma? (don’t focus on this as much for the COPD symptoms as that’s a different q)
Asthma: Dry cough Breathlessness Chest tightness Wheezing
COPD: Productive cough Breathlessness doing simple activity Wheezing chest tightness
describe the differences between asthma, chronic bronchitis, bronchiectasis and emphysema?
Asthma: symptoms are variable, triggered by something, nocturnal symptoms
emphysema: low BMI, oxygen therapy needed, breathlessness at rest
Chronic Bronchitis: seasonal, daily sputum, recurrent infections
Bronchiectasis: inflamed, scarred, thickened airways, lots of sputum production, recurrent infection and crackles on examination
