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Y4 Resp > COPD > Flashcards

COPD Flashcards

1
Q

what are the two types of COPD?

A

chronic bronchitis

emphysema

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2
Q

what is required for a diagnosis of chronic bronchitis?

A

cough and sputum production on

most days for 3mo of 2 successive years

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3
Q

what is required for a diagnosis of emphysema?

A

histological diagnosis of enlarged air

spaces distal to terminal bronchioles ̄c destruction of alveolar walls.

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4
Q

state three causes of COPD?

A

􏰀 Smoking
􏰀 Pollution
􏰀 α1ATD (Alpha-1-antitrypsin deficiency (allows elastin to be broken down by elastase therefore tissue destruction)

Age

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5
Q

state three clinical signs of hyperinflation of the chest?

A

􏰁 ↓Cricosternal distance (normal = 3 fingers)
􏰁 Loss of cardiac dullness
􏰁 Displaced liver edge

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6
Q

which type of COPD has cyanosis ?

A

Pink Puffers in emPhysema

Blue Bloaters in chronic Bronchitis
- therefore chronic bronchitis

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7
Q

does emphysema have increased or decreased alveolar ventilation?

A

increased alveolar ventilation

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8
Q

does chronic bronchitis have increased or decreased alveolar ventilation?

A

decreased alveolar ventilation

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9
Q

which type of COPD has breathlessness ?

A

emphysema

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10
Q

what type of resp failure does chronic bronchitis develop into ?

A

Progress → T2 respiratory failure and cor pulmonale

- due to decreased alveolar ventilation

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11
Q

what type of resp failure does emphysema develop into ?

A

Progress → T1 respiratory failure

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12
Q

what are complications of COPD?

A 
􏰀 Acute exacerbations ± infection
􏰀 Polycythaemia
􏰀 Pneumothorax (ruptured bullae)
􏰀 Cor Pulmonale
􏰀 Lung carcinoma
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13
Q

what score is used to determine the severity of breathlessness?

A

mMRC Dyspnoea Score

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14
Q

what are the 5 aspects of mMRC Dyspnoea Score?

A
  1. Dyspnoea only on vigorous exertion
  2. SOB on hurrying or walking up stairs
  3. Walks slowly or has to stop for breath
  4. Stops for breath after <100m / few min
  5. Too breathless to leave house or SOB on dressing
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15
Q

what two DD should be ruled out before a diagnosis of chronic bronchitis is made?

A

TB, bronchiectasis

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16
Q

what morphological changes occur in the small and large airways?

A

Large Airways
• Mucous gland hyperplasia (increase in size)
• Goblet cell hyperplasia (cilia is lost and transparent goblet cells cover the epithelium)
• Inflammation and fibrosis is a minor component

Small Airways
• Goblet cells appear
• Inflammation and fibrosis in long standing disease (vessels lose shape and look jaggy/disorganized)

17
Q

what will CXR show for COPD?

A

􏰁 Hyperinflation (> 6 ribs anteriorly)
􏰁 Prominent pulmonary arteries
􏰁 Peripheral oligaemia
􏰁 Bullae

18
Q

what FEV1 measurements correlate with which severity of COPD?

A

􏰀 Mild: FEV1 >80% (but FEV/FVC <0.7 and symptomatic)

􏰀 Mod: FEV1 50-79%

􏰀 Severe: FEV1 30-49%

􏰀 Very Severe: FEV1 < 30%

19
Q

what three bloods tests can be done for COPD?

A

FBC (polycythaemia), α1-AT level, ABG

20
Q

what general measures can be addressed for COPD?

A

smoking cessation
- specialist nurse, nicotine replacement, Bupropion (partial nicotinic agonist)

pulmonary exercise

good diet and wt loss

influenza and pneumococcal vaccine

review once/twice a yr

air travel risky if FEV1<50%

21
Q

what does LTOT stand for ?

A

Long-term oxygen therapy

22
Q

what is the difference between asthma and COPD?

A

asthma is reversible

23
Q

what patients would have long term oxygen therapy ?

A

Clinically stable non-smokers ̄c PaO2 <7.3

PaO2 7.3 – 8 + PHT / cor pulmonale / polycythaemia /
COPD
nocturnal hypoxaemia

Terminally ill pts.

24
Q

what three things can be done in surgery for COPD?

A

􏰀 Recurrent pneumothoraces
􏰀 Isolated bullous disease
􏰀 Lung volume reduction

25
Q

what type of drug is ipratropium?

A

Short-acting muscarinic antagonist (SAMA)

26
Q

what medication can be given for COPD which has symptoms of Breathlessness and/or exercise limitation?

A

􏰀 SABA and/or SAMA (ipratropium) as required

27
Q

what medication can be given for COPD which has symptoms of persistent breathlessness or exacerbations ?

A

􏰀 FEV1 >50%: LABA or LAMA (tiotropium) (stop SAMA)

􏰀 FEV1 <50%: LABA+ICS combo or LAMA

28
Q

what type of medication is tiotropium?

A

Long-acting muscarinic antagonist (LAMA)

29
Q

what medication can be given for COPD which has symptoms of persistent exacerbations or breathlessness?

A

􏰀 LABA+LAMA+ICS

􏰀 Roflumilast / theophylline (PDIs) may be considered

􏰀 Consider home nebs

30
Q

what type of medication is theophylline?

A

xanthines

  • phosphodiesterase inhibitor, adenosine receptor blocker, and histone deacetylase activator.
  • smooth muscle relaxant
31
Q

what 4 key questions should be asked about acute COPD exacerbation?

A

􏰀 Smoking status
􏰀 Exercise capacity
􏰀 Current treatment
􏰀 Previous exacerbations

32
Q

what are DD for acute exacerbation of COPD?

A

􏰀 Pneumothorax
􏰀 Pulmonary oedema
􏰀 PE
􏰀 Asthma

33
Q

what oxygen therapy should be given initially for acute exacerbation of COPD?

A

􏰀 24% O2 via Venturi mask: SpO2 88-92%,
􏰀 Vary FiO2 and SpO2 target according to ABG
􏰀 Aim for PaO2 >8 and ↑ in PCO2 of <1.5kPa

34
Q

what can be nebulised during an acute exacerbation of COPD?

A

􏰀 Salbutamol 5mg/4h

􏰀 Ipratropium 0.5mg/6h

35
Q

what steroids can be given during an acute exacerbation of COPD?

A

􏰀 Hydrocortisone 200mg IV

􏰀 Prednisolone 40mg PO for 7-14d

36
Q

what antibiotic should be given if an infection is suspected with an acute exacerbation of COPD?

A

Doxy 200mg PO STAT then 100mg OD PO for 5d

37
Q

what is the management for acute exacerbation of COPD with no response to treatment ?

A

􏰀 Repeat nebs and consider aminophylline IV
􏰀 Consider NIV (BiPAP) if pH<7.35 and/or RR >30
􏰀 Consider invasive ventilation if pH<7.26

Y4 Resp (17 decks)

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