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Respiratory > COPD > Flashcards

COPD Flashcards

1
Q

What conditions are encompassed by COPD?

A

Chronic bronchitis

Emphysema

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2
Q

COPD is irreversible and progressive. T/F?

A

True

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3
Q

What is the biggest risk factor for the development of COPD?

A

Smoking

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4
Q

Other than smoking, what other factors can be implicated in COPD?

A

Environmental pollution
Burning of biomass fuels
Occupational dust
Alpha 1 Anti-trypsin deficiency

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5
Q

What are the effects of smoking on the lungs?

A 
Reduced filial motility
Airway inflammation
Mucous hypertrophy
Hypertrophy of goblet cells
Increased protease activity
Anti-protease inhibition
Oxidative stress
Squamous metaplasia
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6
Q

How does alpha one anti-trypsin deficiency result in COPD?

A

Alpha one antitrypsin is a serine proteinase inhibitor. Patients with a deficiency are unable to counterbalance destructive enzymes in the lung.

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7
Q

At what age do non-smokers with alpha one antitrypsin deficiency develop COPD?

A

30-40 years

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8
Q

What symptom of COPD is specific to chronic bronchitis?

A

Production of sputum on most days for at least 3 months in at least 2 years

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9
Q

What is emphysema?

A

Abnormal, permanent enlargement of the airspaces distal to the terminal bronchioles

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10
Q

Which cells are the main drivers of inflammation in chronic bronchitis and COPD?

A

Neutrophils

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11
Q

Small airways disease may be an early feature of COPD. T/F?

A

True

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12
Q

Why does bronchiole narrowing occur in chronic bronchitis?

A

Mucous plugging
Inflammation
Fibrosis

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13
Q

What cells are implicated in inflammation in chronic bronchitis?

A

Macrophages
CD8+ T cells
Neutrophils

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14
Q

What inflammatory mediators are involved in chronic bronchitis?

A

TNF
IL-8
Other cytokines

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15
Q

What substances do activated neutrophils produce in chronic bronchitis?

A

Neutrophil elastase
Proteinase 3
Cathepsin G

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16
Q

What substances do activated macrophages produce in chronic bronchitis?

A

Elastase

Matrix metalloproteinases

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17
Q

What types of emphysema contribute to COPD?

A

Centri-acinar emphysema

Pan-acinar emphysema

18
Q

Where in the lungs does centri-acinar emphysema cause damage?

A

Around respiratory bronchioles

Mostly in the upper lobes

19
Q

Where in the lungs does pan-acinar emphysema cause damage?

A

Uniform enlargement from the level of the terminal bronchiole distally

20
Q

What type of emphysema is associated with alpha one anti-trypsin deficiency?

A

Pan-acinar emphysema

21
Q

Why is there breathlessness in COPD?

A

Air trapping

Hyperinflation

22
Q

What signs of COPD are seen on CXR?

A

Hyperinflation appears as very dark looking lungs with >6 anterior ribs seen
Heart is thin
Hemi-diaphragm flattens

23
Q

What are the symptoms/signs of COPD?

A 
Exertional breathlessness
Chronic cough
Regular sputum production
Frequent winter bronchitis
Wheeze
24
Q

What % predicted FEV1 indicates stage one COPD?

A

80%

25
Q

What % predicted FEV1 indicates stage two COPD?

A

50-79%

26
Q

What % predicted FEV1 indicates stage three COPD?

A

30-49%

27
Q

What % predicted FEV1 indicates stage four COPD?

A

<30%

28
Q

What therapies are used to treat COPD?

A 
Inhaled bronchodilators
Inhaled corticosteroids
Oral theophylline
Mucolytics (carbocysteine)
Nebuliser therapy
29
Q

Give an example of a short acting inhaled bronchodilator?

A

Salbutamol

30
Q

Give an example of a long acting inhaled bronchodilator?

A

Salmeterol

Tiotropium

31
Q

Give examples of inhaled corticosteroids used in COPD

A

Budenoside

Fluticasone

32
Q

What symptoms/signs of type 2 respiratory failure are seen in COPD patients?

A 
Cyanosis
Warm peripheries
Boudning pulse
Flappign temor
Confusion
Drowsiness
Right sided heart failure
Oedema
Raised JVP
33
Q

What symptoms/signs of type 1 respiratory failure are seen in COPD patients?

A 
Desaturate on exercise
Pursed lip breathing
Use of accessory muscles
Wheeze
Undraping of intercostals
Tachypnoea
34
Q

What are some of the main differences between COPD and asthma?

A

Strong smoking history in COPD, possible non-smokers in asthma
Asthma often occurs <35 years
Chronic productive cough common in COPD but not in asthma
Breathlessness is persistent and progressive in COPD but variable in asthma
Night time symptoms in asthma
Significant diurnal variability in asthma
Eosinophils and CD4+T cells in asthma, CD8+ T cells and neutrophils in COPD
Asthma is reversible, COPD is irreversible

35
Q

Define an exacerbation of COPD

A

A sustained worsening of the patient’s symptoms from their usual stable state, which is beyond day-to-day variations nd is cute in onset.

36
Q

How should an exacerbation of COPD be assessed?

A

Symptoms
ABG
CXR

37
Q

Why are the target oxygen saturations in COPD lower than for other patients?

A

Normally, respiratory drive is determined by carbon dioxide levels, sensed by chemoreceptors. In COPD there is chronic high carbon dioxide in the blood due to the obstruction of expiration and so the body will desensitise to this and will start using oxygen levels to determine respiratory drive. Thus, giving oxygen will. worsen type 2 respiratory failure as the increase in oxygen levels could remove the patient’s respiratory drive.

38
Q

How should patients with exacerbations of COPD be treated?

A 
Nebulised salbutamol 2.5-5mg
Ipatropium bromide 0.5mg
Consider iV aminophylline if no improvement
Prednisolone 40mg
Antibiotics if signs of infection
Non-invasive ventilation
39
Q

What scoring system can be used to assess breathlessness in COPD?

A

MRC dyspnoea scale

40
Q

What criteria must a patient meet to qualify for long term oxygen therapy in COPD?

A

PaO2 of <7.3 kPa when stable
OR
PaO2 of 7.3 - 8 kPa and any of secondary polycythaemia, nocturnal hyperaemia, peripheral oedema and pulmonary hypertension

Respiratory (10 decks)

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