COPD Flashcards
What are the 3 types of lung fibrosis?
- Replacement fibrosis secondary to lung damage
- Focal fibrosis in response to inhaled irritants
- Diffuse parenchymal lung disease
Name 2 conditions in which diffuse parenchymal lung disease can be seen
- Idiopathic pulmonary fibrosis
2. Extrinsic allergic alveolitis
Name 4 connective tissue diseases that can occur in association with pulmonary fibrosis
- Rheumatoid arthritis
- SLE
- Systemic sclerosis
- Sjorgen’s syndrome
Name 3 medications that can cause lung fibrosis
- Amiodarone
- Nitrofurantoin
- Bleomycin
How would you calculate a smokers ‘pack years’?
Multiply the number of packs of cigarettes smoked per day by the number of years they have smoked.
What are the 3 hallmark symptoms of COPD?
- SOB
- Chronic Cough
- Sputum production
What is the main marker for genetic susceptibility to COPD?
Alpha-1 antitrypsin deficiency
Name 4 gene polymorphisms that confer a genetic susceptibility to the development of COPD
- Alpha-1 antitrypsin deficiency
- Matrix metalloproteinases
- TNF-alpha
- glutathione S transferase
What are the 3 main pathological changes seen within the lungs in patients with COPD?
- Goblet cell hyperplasia
- Airway narrowing
- Alveolar destruction
How is airway obstruction defined clinically?
Post- bronchodilator FEV1/FVC ratio such that FEV1/FVC is less than 0.7
Recall the stages of the GOLD categorisation of COPD severity
Stage 1 - FEV1 > 80% predicted
Stage 2 - FEV1 50-79% predicted
Stage 3 - FEV1 30-49% predicted
Stage 4 - FEV1 <30% predicted
Suggest 2 changes to the CXR seen in patients with COPD
- Hyperexpansion
2. Low, flat diaphragms
Outline the 3 broad stages of COPD pathophysiology
- Airflow obstruction
- Impaired gas exchange
- Hypoxia and hypercapnia
Outline the 5 stages of the pathophysiology associated with Cor Pulmonale
- Hypoxia
- Pulmonary arterial vasoconstriction
- Increased pulmonary arterial pressure
- Right ventricular hypertrophy
- Right ventricular failure
Name a nicotine receptor blocker
Varenicline
Name the 3 drug classes that can be used in the management of COPD
- Inhaled bronchodilators
- Inhaled corticosteriods
- Oral theophylline
Name 2 short acting beta-2 agonists
- Salbutamol
2. Terbutaline
Name 2 long acting beta-2 agonists
- Salmeterol
2. Eformoterol
Name 2 anti-muscarinic agents used in the treatment of COPD
- Ipratropium
2. Tiotropium
Name 3 inhaled corticosteroids used in the treatment of COPD
- Beclomethasone
- Budesonide
- Fluticasone
Name an oral theophylline
Aminophylline
Name a mucolytic used in the management of COPD
Carbocysteine
Name 2 vaccinations that should be given to patients with COPD
- Influenza
2. Pneumococcal
Give 6 complications associated with COPD
- Exacerbations
- Pneumonia
- Pneumothorax
- Right ventricular failure
- Peripheral neuropathy
- Cachexia
What is the most common bacterial cause of COPD exacerbation?
Haemophilus influenza
Suggest 6 symptoms commonly associated with a COPD exacerbation
- Preceding Coryzal symptoms
- Increased breathlessness
- Increased cough
- Increased sputum
- Sputum purulence
- Ankle swelling
Outline the 3 main types of PFTs used to assess lung function
- Spirometry
- Lung diffusion test
- Lung Plethysmography
What is measured in each of the 3 standard PFT tests?
- Spirometry - Measures the volume of air breathed in and out
- Lung diffusion test - Measures the degree of oxygen transfer from the inspired air to the alveolar blood supply
- Lung Plethysmography - Measures the amount of air present in the lungs after exhalation
Define Vital capacity
The amount of air that can be exhaled following a full inspiration
Define FCV
Forced vital capacity - the maximum volume of air that you can forcibly exhale after taking the deepest breath possible
Name 6 examples of obstructive lung disease
- COPD
- Asthma
- Chronic bronchitis
- Bronchiectasis
- Bronchiolitis
- Cystic fibrosis
Suggest 7 potential causes of intrinsic restrictive lung disease
- Pneumonia
- Pneumoconioses
- ARDS
- Eosinophilic pneumonia
- TB
- Sarcoidosis
- Pulmonary fibrosis
What is pneumoconiosis?
Refers to a group of lung diseases caused by the inhalation and retention of dust particles within the lungs
What are the 4 sub-classifications of pneumoconiosis?
- Coal workers pneumoconiosis
- Asbestosis
- Silicosis
- Other unspecified pneumoconiosis
Suggest 8 causes of extrinsic restrictive lung disease
- Scoliosis
- Obesity
- Obesity hypoventilation syndrome
- Pleural effusion
- Malignant tumours
- Ascites
- Pleurisy
- Rib fractures
Suggest 5 causes of neurological restrictive lung disease
- Paralysis of the diaphragm
- Gullian-Barre syndrome
- Myasthenia Gravis
- Muscular dystrophy
- Amyotrophic lateral sclerosis (ALS)
What are the 3 main features of the reversible airway obstruction associated with asthma?
- Bronchoconstriction
- Bronchial mucosal oedema
- Mucus plugging
Define COPD
Lung disease characterised by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible
What are the 3 main features of airway obstruction associated with COPD?
- Bronchoconstriction
- Mucosal oedema
- Mucosal hypersecretion
Recall the 3 subcategories of bronchodilators that are used in the treatment of obstructive airway disease
- Sympathomimetic agents
- Xanthines
- Magnesium
Recall 6 side effects that can be associated with the use of beta-2 agonists
- Tachycardia
- Arrhythmia
- Myocardial ischaemia
- Tremor
- Paradoxical bronchospasm
- Hypokalaemia
What is the most common short acting anticholinergic drug used in the treatment of COPD?
Ipratropium bromide
Classify the drug tiotropium
Long acting anticholinergic
Name the 3 classical side effects associated with the use of anticholinergic drugs.
- Dry mouth
- Nausea
- Headache
Name 2 important contra-indications for the use of anticholinergic agents
- Prostatic hyperplasia + bladder outflow obstruction
2. Glaucoma
What is the main mechanism of action of xanthines?
Increased availability of cAMP thus unregulated activities of SNS to induce bronchodilitation. May also indirectly have an anti inflammatory effect via another mechanism.
Give 5 important side effects associated with inhaled corticosteroids
- Candidiasis
- Hoarseness
- Adrenal suppression
- Osteoporosis
- Growth restriction in children
Seretide is a combination of which 2 drugs?
Salmeterol and Fluticasone
Name 4 cell types that release leukotrienes as part of the inflammatory response
- Eosinophils
- Mast cells
- Macrophages
- Basophils
Name a leukotriene receptor antagonist that can be used in the treatment of COPD
Montelukast
What is the proposed mechanism of action of sodium cromoglycate as an anti inflammatory in the management of COPD/asthma?
May inhibit degranulation of mast cells but mechanism is not fully understood
What is Omalizumab?
Monoclonal antibody that binds to IgE
Name a condition for which Omalizumab may be indicated
Severe persistant allergic asthma
What is the most common mucolytic used in the treatment/ management of COPD?
Carbocisteine
Suggest 6 clinical features associated with hypercapnia
- Dilated pupils
- Bounding pulse
- Hand flap
- Myoclonus
- Confusion
- Drowsiness
Give 4 signs associated with COPD on CXR
- Flattened diaphragm
- Smaller heart size
- Hyperinflated lungs
- Horizontal rib markings
What are the 5 most common organisms causing infective exacerbations of COPD?
- Strep Pneumonia
- Viruses
- Moraxella Catarrhalis
- Haemophilus influenza
- Pseudomonas aeruginosa
When is long term home oxygen therapy indicated in patients with COPD?
PaO2 <7.3kPa on air
What is the definition of chronic bronchitis?
Chronic productive cough for at least 3 months in the last 2 years
Suggest 4 potential causes of COPD
- Smoking
- Alpha 1 anti-trypsin deficiency
- Cadmium
- Coal
Which 2 medical conditions often coexist in patients with COPD?
Chronic bronchitis and emphysema
