COPD Flashcards
Symptoms?
Dyspnoea, cough +/- sputum
Which cells are recruited?
Neutrophils, CD8-T cells, macrophages and fibroblasts
What is the difference in spirometry results between restrictive and obstructive disease?
Restrictive: impaired volume spirometry
Obstructive: impaired flow spirometry
What pathological process is caused by fibroblasts?
Abnormal tissue repair
Where does narrowing start?
In the periphery near the alveoli (<2mm)
What causes the ‘barrel chest’?
Hyperinflation and gas trapping due to incomplete expiration
TGF-beta and other growth factors cause what in COPD?
Airway fibrosis
Genetic absence of anti-protease alpha-1 anti-trypsin leads to what?
Early-onset COPD
Percussion of COPD?
Hyper-resonant
Auscultation of COPD?
Distant breath sounds (hyperinflation)
Poor air movement (loss of tissue elasticity and tissue breakdown)
Wheeze (airway inflammation and resistance)
Coarse crackles (mucus in airway - either inflammation or exacerbation)
What added complications will cor pulmonale cause for the COPD patient?
Cyanosis Loud P2 Hepatojugular reflux Heptosplenomegaly Lower-extremity swelling Distended neck veins
Which COPD patients may present with clubbing?
Those who have developed secondary bronchiectasis or lung cancer
What is the definition of a COPD exacerbation?
Acute worsening of symptoms requiring additional treatment
What examination finding can hypercapnia cause?
Asterixis (hand flap)
What finding is required for diagnosis?
Obstructive spirometry
FEV1/FVC
< 0.7
Mild COPD:
FEV1 > or equal to 80%
Moderate COPD:
FEV1 = 50-79%
Severe COPD:
FEV1 = 30-49%
Very severe COPD:
FEV1 < 30%
Which spirometry values increase with COPD?
Functional residual capacity and residual volume
Which spirometry value decreases with COPD?
Inspiratory reserve volume
When would a COPD patient be exercise limited?
Once the inspiratory reserve volume is within 0.5L of the total lung capacity
What causes gas trapping?
Airway collapse (equal pressure point reached before cartilage)
What is a normal FEV1/FVC reading?
~75%
Which two conditions come under COPD?
Chronic bronchitis and emphysema
Which condition is associated with being a ‘blue bloater’?
Chronic bronchitis
Which condition is associated with being a ‘pink puffer’?
Emphysema
Chronic bronchitis =
Chronic inflammation with excess mucus and productive chronic cough
What are the symptoms of chronic bronchitis?
Productive cough with progression to intermittent dyspnoea
Frequent and recurrent pulmonary infections
Progressive cardiac/respiratory failure
Oedema
Weight gain (due to inactivity)
Histology of chronic bronchitis airway:
Stratified columnar with cilia –> squamous metaplasia (cilia lost) with goblet cell hyperplasia
Is COPD reversible?
No
What can panacinar emphysema lead to?
Pneumothorax in the form of bullous sub pleural gas pockets
IL-6, IL-1 beta and TNF-alpha are all released in COPD, which other co-morbidities can they lead to?
Ischaemic heart disease, Cor pulmonale Muscle cachexia Osteoporosis Diabetes - Metabolic syndrome Normogenic anaemia Depression
Mild acute exacerbation:
SABD (albuterol or levalbuterol) then if needed: \+ Systemic corticosteroid \+ Then transition to ICS \+ Oral antibiotic \+ O2 with target sats of 88-92%
Which mask should be used for O2 therapy?
Venturi
Why should you monitor the O2 therapy by measuring ABGs?
To check for hypercapnia and CO2 retention
What symptom prompts giving O2?
Hypoxia not SOB
When is non-invasive ventilation indicated?
Respiratory acidosis: (PaCO2 > 6 kPa, pH < 7.35)
Fatigue
Persistent hypoxaemia
When is intubation/invasive ventilation indicated?
Post-arrest
Fading consciousness
Haemodynamic instability / arrhythmia
Aspiration / vomiting
Best smoking cessation therapy available =
Varenidine followed by combination nicotine replacement
What are more effective at reducing exacerbations, antimuscarinics or LABAs?
Antimuscarinics
What is an important prophylactic measure to reduce the likelihood of exacerbations?
Vaccinations:
Flu
Pneumococcal (reduces bacteraemia risk)
LABAs:
Formoterol, Salmeterol, Indacterol and Olodacterol
-amol
SABA
-erol
LABA
-ium
LAMA
Combination LABA and LAMA medications:
Glycopyrronium + indacaterol (Ultibro)
Umeclodinium + vilanterol (Anoro ellipta)
Aclidinium + formoterol (Genuair)
