COPD Flashcards

1
Q

Mechanisms of Airflow limitation in COPD

A
  1. Mucus hypersecretion: luminal obstruction.
  2. Disrupted alveolar attachments: emphysema.
  3. Mucosal & peribronchial inflammation & fibrosis (obliterative bronchiolitis).
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2
Q

Disease process in COPD

A

Cigarette Smoke => Alveolar macrophage <=> Neutrophil => Proteases => Emphysema & Chronic Bronchitis => Progressive airflow limitation.

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3
Q

Two aspects of COPD

A

Chronic Bronchitis & Emphysema

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4
Q

Chronic Bronchitis

A
  • Chronic Neutrophilic inflammation.
  • Mucus hypersecretion.
  • Mucociliary dysfunction.
  • Altered lung biome.
  • Smooth muscle spasm & hypertrophy.
  • Partially reversible.
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5
Q

Emphysema

A
  • Alveolar destruction.
  • Impaired gas exchange.
  • Loss of bronchial support.
  • Irreversible.
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6
Q

Symptoms of COPD

A
  • Productive cough.
  • Progressive dyspnoea (SOB)
  • Frequent infections.
  • Wheezing (Chronic Bronchitis)
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7
Q

Signs of COPD

A
  • Reduced Breath sounds (Emphysema)
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8
Q

Complications of COPD

A

Pulmonary hypertension & RV hypertrophy/failure (cor pulmonale)

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9
Q

Chronic cascade in COPD

A

Progressive fixed airflow obstruction => impaired alveolar gas exchange => Resp failure (decreased PaO2, increased PaCO2)

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10
Q

COPD History

A

Smoking

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11
Q

Corticosteroids in COPD

A

May cause pneumonia due to local immune suppression & impaired Mucociliary clearance (especially fluticasone due to prolonged lung retention).

Reduces exacerbations in Eosinophilic COPD (ACO)

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12
Q

Oral steroids

A

Prednisolone used for acute exacerbations.

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13
Q

Inhaled steroids

A

Beclomethasone used for maintenance monotherapy in asthma.

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14
Q

Bronchodilators: B2 agonists

A

Stimulate bronchial smooth muscle B2 receptors: Increased cAMP.

SABA or LAMA.

LAMA/LABA or ICS/LABA/LAMA used.

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15
Q

Bronchodilators: Muscarinic Antagonists (anti-cholinergics)

A

Block post-junctional end plate M3 receptors.

SAMA (Ipratropium) & LAMA (Tiotropium)

Chronic: LAMA or LAMA/LABA or ICS/LAMA/LABA. To reduce exacerbations.

Acute: High Nebulised doses of ipratropium.

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16
Q

Route of Administration of SAMA & LAMA

A

Inhalation

17
Q

Bronchodilator/Anti-inflammatory: Methylxanthines

A

Non-selective phosphodiesterase inhibitor (increased cAMP). Also acts as adenosine antagonist.

Chronic:

  • Oral (theophylline).
  • Used as add-on with ICS.

Acute:
- IV (aminophylline)

18
Q

Anti-inflammatory: PDE4 inhibitors

A

Anti-inflammatory action & reduces exacerbations.

E.g. Oral roflumilast.

Used as add-on to LABA or LAMA/

19
Q

Adverse effects of Roflumilast (PDE4 inhibitor)

A

Nausea, diarrhoea, headache, weight loss.

20
Q

Mucolytics

A

Reduce sputum viscosity. aid sputum expectoration & reduce exacerbations.

E.g. Oral carbocisteine & erdosteine.

21
Q

Non-pharmacological treatment for Chronic COPD

A
  • Smoking cessation.
  • Influenza/pneumococcal immunisation.
  • Physical activity.
  • Domicilary oxygen.
22
Q

Pharmacological treatment of Chronic COPD

A
  • LABA/LAMA combo.
  • ICS/LABA/LAMA combo (if high eosinophil count).
  • Roflumilast.
  • Carbocisteine.
  • Antibiotics for infections - Azithromycin.
23
Q

Treatment of Acute COPD

A
  • Nebulised high dose SABA (Salbutamol) + SAMA (Ipratropium).
  • Oral prednisolone.
  • Antibiotic (amoxicillin/doxycycline) if infection.
  • Oxygen: 24-28% titrated against PaO2/PaCO2.
  • Physio to aid sputum expectoration.
  • Non-invasive ventilations.
  • ITU assisted ventilation if reversible component (e.g. pneumonia)