COPD Flashcards
(30 cards)
What is COPD?
A disease characterised by persistent respiratory sysmptoms and airflow limitation due to airway and alveolar abnormalities
Encompasses emphysema and chronic bronchitis
What is the cause of COPD?
- Significant exposure to noxious particles or gases
- Smoking
- Biomass exposure
- Air pollution
- Illicit drug use
-
alpha-1-antitrypsin deficiency (less common)
* deficiency in antiprotease causes imbalance of protease causing destruction of alveolar walls
What is the prevenelnce of COPD in the UK
1.2 million people (~2% of the population)
Which age group is COPD more common in?
Older individuals
What pathological changes occure in COPD?
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
What happens to the aiways in chronic bronchitis?
Excessive mucus secretion and impaired removal of secretions due to reduced ciliary dysfunction
What happens to the airways in emphysema?
Elastin breakdown and subsequent loss of alveolar integrity causes enlarged airspaces distal to the terminal bronchioles
How do you diagnose COPD?
You need both a Symptom and a Risk Factor and confirm with Spirometry
What are some of the symptoms of COPD?
- 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
What are some risk factors for COPD?
- Host factors
- Tobacco
- Occupation
- Indoor/ outdoor pollution
What are some of the physical signs you may find on examination of a patient with COPD?
- Tachypnoea- to compensate for hypoxia and hypoventilation
- Use of accessory muscles fro breathing
- Barrel Chest - due to hyperinflation and airtrapping
- Hyper-resonance percussion - due to hyperinflation and airtrapping
- Reduced intensity of breath sounds
- Prolonged expiratory phase
- Purse lipped breathing
What are some of the late stage signs of COPD?
- Central Cyanosis
- Flapping Tremors (from CO2 retention)
- Signs of right sided HF (distended neck veins, hepatomegaly, ankle oedema)
What findings will you see on spirometry if someone has COPD?
Obstructive Pattern FEV1/ FEV ratio <70%
Scalloping on Flow- Volume loop
Aside from spirometry, what other investigations would you do if you suspect COPD?
-
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
What is an exacerbation of COPD?
An acute worsening of respiratory symptoms that result in additonal therapy
Explain what the ‘frequent exacerbator’ phenotype is?
Previous exacerbations are the strongest risk factor for exacerbating again
What kind of things can cause exacerbations of COPD?
- 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
What are the goals of COPD treatment?
Improve Symptoms
- relieve dyspnoea
- Improve exercise tolerance
- Improve health related QoL
Reduce Risk
- slow disease progression
- Prevent/ treat exacerbations
- Reduce mortality
How can COPD be treated?
- 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
How does pulmonary rehabilitation for COPD patients work?
- 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
What is the benefit of stopping smoking?
Stopping smoking slows the rate of FEV1 decline to that of someone who has never smoked
It is never too late
What can be done to help someone stop smoking?
- Nicotine replacement therapy
- Champix
- Behavioural Support
- (Vaping)
How do bronchodilators helps patients with COPD?
- Relax airway smooth muscle to increase airway calibre
- Reduce breathlessness
- Reduce exacerbations
What bronchodilators can be used in COPD?
- B2 agonists
- Anti-muscarinics
Usually given as long acting bronchodilators as maintenance therapy
