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Supporting Life > COPD > Flashcards

COPD Flashcards

1
Q

Symptoms?

A

Dyspnoea, cough +/- sputum

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2
Q

Which cells are recruited?

A

Neutrophils, CD8-T cells, macrophages and fibroblasts

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3
Q

What is the difference in spirometry results between restrictive and obstructive disease?

A

Restrictive: impaired volume spirometry
Obstructive: impaired flow spirometry

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4
Q

What pathological process is caused by fibroblasts?

A

Abnormal tissue repair

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5
Q

Where does narrowing start?

A

In the periphery near the alveoli (<2mm)

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6
Q

What causes the ‘barrel chest’?

A

Hyperinflation and gas trapping due to incomplete expiration

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7
Q

TGF-beta and other growth factors cause what in COPD?

A

Airway fibrosis

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8
Q

Genetic absence of anti-protease alpha-1 anti-trypsin leads to what?

A

Early-onset COPD

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9
Q

Percussion of COPD?

A

Hyper-resonant

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10
Q

Auscultation of COPD?

A

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)

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11
Q

What added complications will cor pulmonale cause for the COPD patient?

A 
Cyanosis
Loud P2
Hepatojugular reflux
Heptosplenomegaly
Lower-extremity swelling
Distended neck veins
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12
Q

Which COPD patients may present with clubbing?

A

Those who have developed secondary bronchiectasis or lung cancer

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13
Q

What is the definition of a COPD exacerbation?

A

Acute worsening of symptoms requiring additional treatment

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14
Q

What examination finding can hypercapnia cause?

A

Asterixis (hand flap)

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15
Q

What finding is required for diagnosis?

A

Obstructive spirometry

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16
Q

FEV1/FVC

A

< 0.7

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17
Q

Mild COPD:

A

FEV1 > or equal to 80%

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18
Q

Moderate COPD:

A

FEV1 = 50-79%

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19
Q

Severe COPD:

A

FEV1 = 30-49%

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20
Q

Very severe COPD:

A

FEV1 < 30%

21
Q

Which spirometry values increase with COPD?

A

Functional residual capacity and residual volume

22
Q

Which spirometry value decreases with COPD?

A

Inspiratory reserve volume

23
Q

When would a COPD patient be exercise limited?

A

Once the inspiratory reserve volume is within 0.5L of the total lung capacity

24
Q

What causes gas trapping?

A

Airway collapse (equal pressure point reached before cartilage)

25
Q

What is a normal FEV1/FVC reading?

A

~75%

26
Q

Which two conditions come under COPD?

A

Chronic bronchitis and emphysema

27
Q

Which condition is associated with being a ‘blue bloater’?

A

Chronic bronchitis

28
Q

Which condition is associated with being a ‘pink puffer’?

A

Emphysema

29
Q

Chronic bronchitis =

A

Chronic inflammation with excess mucus and productive chronic cough

30
Q

What are the symptoms of chronic bronchitis?

A

Productive cough with progression to intermittent dyspnoea
Frequent and recurrent pulmonary infections
Progressive cardiac/respiratory failure
Oedema
Weight gain (due to inactivity)

31
Q

Histology of chronic bronchitis airway:

A

Stratified columnar with cilia –> squamous metaplasia (cilia lost) with goblet cell hyperplasia

32
Q

Is COPD reversible?

A

No

33
Q

What can panacinar emphysema lead to?

A

Pneumothorax in the form of bullous sub pleural gas pockets

34
Q

IL-6, IL-1 beta and TNF-alpha are all released in COPD, which other co-morbidities can they lead to?

A 
Ischaemic heart disease,
Cor pulmonale
Muscle cachexia
Osteoporosis
Diabetes - Metabolic syndrome
Normogenic anaemia
Depression
35
Q

Mild acute exacerbation:

A 
SABD (albuterol or levalbuterol) then if needed:
\+ Systemic corticosteroid
\+ Then transition to ICS
\+ Oral antibiotic
\+ O2 with target sats of 88-92%
36
Q

Which mask should be used for O2 therapy?

A

Venturi

37
Q

Why should you monitor the O2 therapy by measuring ABGs?

A

To check for hypercapnia and CO2 retention

38
Q

What symptom prompts giving O2?

A

Hypoxia not SOB

39
Q

When is non-invasive ventilation indicated?

A

Respiratory acidosis: (PaCO2 > 6 kPa, pH < 7.35)
Fatigue
Persistent hypoxaemia

40
Q

When is intubation/invasive ventilation indicated?

A

Post-arrest
Fading consciousness
Haemodynamic instability / arrhythmia
Aspiration / vomiting

41
Q

Best smoking cessation therapy available =

A

Varenidine followed by combination nicotine replacement

42
Q

What are more effective at reducing exacerbations, antimuscarinics or LABAs?

A

Antimuscarinics

43
Q

What is an important prophylactic measure to reduce the likelihood of exacerbations?

A

Vaccinations:
Flu
Pneumococcal (reduces bacteraemia risk)

44
Q

LABAs:

A

Formoterol, Salmeterol, Indacterol and Olodacterol

45
Q

-amol

A

SABA

46
Q

-erol

A

LABA

47
Q

-ium

A

LAMA

48
Q

Combination LABA and LAMA medications:

A

Glycopyrronium + indacaterol (Ultibro)
Umeclodinium + vilanterol (Anoro ellipta)
Aclidinium + formoterol (Genuair)

Supporting Life (14 decks)

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