COPD Flashcards
What conditions are encompassed by COPD?
Chronic bronchitis
Emphysema
COPD is irreversible and progressive. T/F?
True
What is the biggest risk factor for the development of COPD?
Smoking
Other than smoking, what other factors can be implicated in COPD?
Environmental pollution
Burning of biomass fuels
Occupational dust
Alpha 1 Anti-trypsin deficiency
What are the effects of smoking on the lungs?
Reduced filial motility Airway inflammation Mucous hypertrophy Hypertrophy of goblet cells Increased protease activity Anti-protease inhibition Oxidative stress Squamous metaplasia
How does alpha one anti-trypsin deficiency result in COPD?
Alpha one antitrypsin is a serine proteinase inhibitor. Patients with a deficiency are unable to counterbalance destructive enzymes in the lung.
At what age do non-smokers with alpha one antitrypsin deficiency develop COPD?
30-40 years
What symptom of COPD is specific to chronic bronchitis?
Production of sputum on most days for at least 3 months in at least 2 years
What is emphysema?
Abnormal, permanent enlargement of the airspaces distal to the terminal bronchioles
Which cells are the main drivers of inflammation in chronic bronchitis and COPD?
Neutrophils
Small airways disease may be an early feature of COPD. T/F?
True
Why does bronchiole narrowing occur in chronic bronchitis?
Mucous plugging
Inflammation
Fibrosis
What cells are implicated in inflammation in chronic bronchitis?
Macrophages
CD8+ T cells
Neutrophils
What inflammatory mediators are involved in chronic bronchitis?
TNF
IL-8
Other cytokines
What substances do activated neutrophils produce in chronic bronchitis?
Neutrophil elastase
Proteinase 3
Cathepsin G
What substances do activated macrophages produce in chronic bronchitis?
Elastase
Matrix metalloproteinases
What types of emphysema contribute to COPD?
Centri-acinar emphysema
Pan-acinar emphysema
Where in the lungs does centri-acinar emphysema cause damage?
Around respiratory bronchioles
Mostly in the upper lobes
Where in the lungs does pan-acinar emphysema cause damage?
Uniform enlargement from the level of the terminal bronchiole distally
What type of emphysema is associated with alpha one anti-trypsin deficiency?
Pan-acinar emphysema
Why is there breathlessness in COPD?
Air trapping
Hyperinflation
What signs of COPD are seen on CXR?
Hyperinflation appears as very dark looking lungs with >6 anterior ribs seen
Heart is thin
Hemi-diaphragm flattens
What are the symptoms/signs of COPD?
Exertional breathlessness Chronic cough Regular sputum production Frequent winter bronchitis Wheeze
What % predicted FEV1 indicates stage one COPD?
80%
What % predicted FEV1 indicates stage two COPD?
50-79%
What % predicted FEV1 indicates stage three COPD?
30-49%
What % predicted FEV1 indicates stage four COPD?
<30%
What therapies are used to treat COPD?
Inhaled bronchodilators Inhaled corticosteroids Oral theophylline Mucolytics (carbocysteine) Nebuliser therapy
Give an example of a short acting inhaled bronchodilator?
Salbutamol
Give an example of a long acting inhaled bronchodilator?
Salmeterol
Tiotropium
Give examples of inhaled corticosteroids used in COPD
Budenoside
Fluticasone
What symptoms/signs of type 2 respiratory failure are seen in COPD patients?
Cyanosis Warm peripheries Boudning pulse Flappign temor Confusion Drowsiness Right sided heart failure Oedema Raised JVP
What symptoms/signs of type 1 respiratory failure are seen in COPD patients?
Desaturate on exercise Pursed lip breathing Use of accessory muscles Wheeze Undraping of intercostals Tachypnoea
What are some of the main differences between COPD and asthma?
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
Define an exacerbation of COPD
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.
How should an exacerbation of COPD be assessed?
Symptoms
ABG
CXR
Why are the target oxygen saturations in COPD lower than for other patients?
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.
How should patients with exacerbations of COPD be treated?
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
What scoring system can be used to assess breathlessness in COPD?
MRC dyspnoea scale
What criteria must a patient meet to qualify for long term oxygen therapy in COPD?
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