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Respiratory System > COPD > Flashcards

COPD Flashcards

1
Q

What is COPD?

A

A disease characterised by persistent respiratory sysmptoms and airflow limitation due to airway and alveolar abnormalities

Encompasses emphysema and chronic bronchitis

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2
Q

What is the cause of COPD?

A
  1. Significant exposure to noxious particles or gases
  • Smoking
  • Biomass exposure
  • Air pollution
  • Illicit drug use
  1. alpha-1-antitrypsin deficiency (less common)
    * deficiency in antiprotease causes imbalance of protease causing destruction of alveolar walls
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3
Q

What is the prevenelnce of COPD in the UK

A

1.2 million people (~2% of the population)

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4
Q

Which age group is COPD more common in?

A

Older individuals

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5
Q

What pathological changes occure in COPD?

A

Small Airways Disease

  • Enlargement of mucus secreting glands
  • Increased number of goblet cells
  • Cilliary Dysfunction

Parenchymal Destruction

  • Breakdown of elastin → destroys alveolar walls
  • Forms large air spaces reducing S.A for gas exchange
  • Vascular bed changes cause pulmonary hypertension
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6
Q

What happens to the aiways in chronic bronchitis?

A

Excessive mucus secretion and impaired removal of secretions due to reduced ciliary dysfunction

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7
Q

What happens to the airways in emphysema?

A

Elastin breakdown and subsequent loss of alveolar integrity causes enlarged airspaces distal to the terminal bronchioles

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8
Q

How do you diagnose COPD?

A

You need both a Symptom and a Risk Factor and confirm with Spirometry

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9
Q

What are some of the symptoms of COPD?

A
  • Dyspnea- progessively worse over time and worse with exercise
  • Chronic Cough - frequently in the morning, usually productive , recurrent wheeze
  • Any pattern of chronic sputum production
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10
Q

What are some risk factors for COPD?

A
  • Host factors
  • Tobacco
  • Occupation
  • Indoor/ outdoor pollution
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11
Q

What are some of the physical signs you may find on examination of a patient with COPD?

A
  1. Tachypnoea- to compensate for hypoxia and hypoventilation
  2. Use of accessory muscles fro breathing
  3. Barrel Chest - due to hyperinflation and airtrapping
  4. Hyper-resonance percussion - due to hyperinflation and airtrapping
  5. Reduced intensity of breath sounds
  6. Prolonged expiratory phase
  7. Purse lipped breathing
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12
Q

What are some of the late stage signs of COPD?

A
  • Central Cyanosis
  • Flapping Tremors (from CO2 retention)
  • Signs of right sided HF (distended neck veins, hepatomegaly, ankle oedema)
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13
Q

What findings will you see on spirometry if someone has COPD?

A

Obstructive Pattern FEV1/ FEV ratio <70%

Scalloping on Flow- Volume loop

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14
Q

Aside from spirometry, what other investigations would you do if you suspect COPD?

A
  • CXR
    • may show hyperinflation
    • Mandatory to rule out other diagnosis
  • High Resolution Computer Tomography
    • if bronchiectasis suspected
  • Full pulmonary function tests
    • static lung volumes asses hyperinflation
    • Gas transfer to look at alveolar destruction
  • Arterial Blood Gas
    • if respiratory failure is suspected
  • Alpha-1-antitrypsin blood test for young patients
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15
Q

What is an exacerbation of COPD?

A

An acute worsening of respiratory symptoms that result in additonal therapy

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16
Q

Explain what the ‘frequent exacerbator’ phenotype is?

A

Previous exacerbations are the strongest risk factor for exacerbating again

17
Q

What kind of things can cause exacerbations of COPD?

A
  • Bacterial
  • Viral
  • Atypical organisms
  • Environmental Factors
  • Eosinophils

Subsequent exacerbations tend to be of the same ‘type’ e.g. previous bacterial will more than likely be bacterial exacerbation in the future

18
Q

What are the goals of COPD treatment?

A

Improve Symptoms

  • relieve dyspnoea
  • Improve exercise tolerance
  • Improve health related QoL

Reduce Risk

  • slow disease progression
  • Prevent/ treat exacerbations
  • Reduce mortality
19
Q

How can COPD be treated?

A
  • Smoking cessation
  • Patient education
  • Pneumococcal vaccination
  • Patient weight, nutrition status and physical activity monitoring
  • Bronchodilators
  • Inhaled corticosteroids
  • Long term O2 therapy
  • Pulmonary rehab
  • Surgical intervention
20
Q

How does pulmonary rehabilitation for COPD patients work?

A
  • COPD patients usually avoid exercise due to breathlessness which lead to muscle weakness and worsening symptoms
  • Pulmonary rehab uses a MDT for supervised hosptial/ community based exercise programmes to break this cycle
  • Also includes patient education and nutrition advice
21
Q

What is the benefit of stopping smoking?

A

Stopping smoking slows the rate of FEV1 decline to that of someone who has never smoked

It is never too late

22
Q

What can be done to help someone stop smoking?

A
  • Nicotine replacement therapy
  • Champix
  • Behavioural Support
  • (Vaping)
23
Q

How do bronchodilators helps patients with COPD?

A
  • Relax airway smooth muscle to increase airway calibre
  • Reduce breathlessness
  • Reduce exacerbations
24
Q

What bronchodilators can be used in COPD?

A
  • B2 agonists
  • Anti-muscarinics

Usually given as long acting bronchodilators as maintenance therapy

25
Q

What is the purpose of long term oxygen treatment in COPD patients?

A
  • Extended periods of hypoxaemia can cause end organ damage and pulmonary hypertension
  • O2 given continously at a low dose for at least 16 hours per day
  • Has been shown to improve survival
26
Q

What is ambulatory oxygen therapy?

A
  • Used during exertion to help patients walk further
  • No prognostic benefit
27
Q

What surgical interventions can be used in COPD?

A

Used as Last Steps

  • removal of large bullae, lung volume reduction and lung transplant
  • Used to improve lung dynamics and improve QoL
28
Q

What are some of the complications of COPD?

A
  • Recurrent pneumonia
  • Pneumothorax (lung parenchyma damage can rupture pleura)
  • Respiratory Failure
  • Cor Pulmonale (Right Heart Failure)
29
Q

How does acute non invasive ventilation work?

A

Inspiratory Positive Airway Pressure (IPAP) increases tidal volume by high pressure O2 delivery on inspiration

Improves symptoms and life expectancy

30
Q

Why do patients with COPD get ankle swelling?

A
  • Reduced O2 causes hypoxopulmonary vasocontriction to maintain V/Q
  • Back pressure causes the heart to undergo hypertrophy due to increased afterload
  • Causes right sided heart failure + hypertension
  • Reduced venous return = fluid remains in ankles

Respiratory System (20 decks)

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