COPD Flashcards
Define COPD
A UN-CURABLE lung disease that is characterised by chronic obstruction of lung airflow and is not FULLY REVERSIBLE
What is main cause of COPD and other causes
- Smoking
- Small lungs
- Females
- Biofuel, pollution certain jobs
What is the name of the important curve in regards to smoking and death
Fletcher- Peto Curve
What is Alpha -1- antitrypsin deficiency
A RARE disease where a protease inhibitor that is normally made in the liver and down regulates elastase is not produced.
What is seen in people with Alpha -1- antitrypsin deficiency
Alveolar damage and emphysema (BASALLY)
Why is smoking really really bad if you have Alpha -1- antitrypsin deficiency
Smoking increases Elastase production
What can Alpha -1- antitrypsin deficiency lead to
Liver disease and cirhosis
What are typical presenting symptoms of COPD
S.O.B
Recurrent chest infections
On going productive cough
Wheeze
What scale is used to measure breathlessness
The MMRC dypsnoea scale (0-4)
What are indirect presenting symptoms of COPD
Weight loss (cachexia) or gain Fatigue Cor Pulmonale Decreased exercise Ankle swelling Depression/Anxiety
If someone comes in with previously diagnosed COPD that is getting worse, what are you looking for
Cyanosis (sat<92%) Raised Jugular Venous pressure Pursed lip (Define) Hyper Inflated chest Peripheral oedema
Whats it called when someone with COPD gets acutely worse symptoms
Acute exacerbation of COPD
How do you diagnose COPD?
Typical Symptoms
Presence of risk factor (eg smoking)
>35 years old
Absence of clinical features of Asthma
How can you differentiate COPD symptoms from Asthma Symptoms?
Post bronchodilator spirometry confrims airway obstruction. (COPD IS NOT REVERSIBLE)
How is FEV1 used to stage COPD?
IF RATIO LESS THAN 80% THEN INDICATES COPD Mild - 80% Moderate - 50-79% Severe - 30-49% Very Severe - <30%
What do you look for on COPD X-ray
Flat Diaphragm
Small (vertical) Heart
Vascular Hila
Bulla
What tests can you use to help diagnose COPD
Spirometry
PEFR (peak expiratroy flow rate)
Chest Xray
In COPD , what happens to the residual volume and total lung capacity
They increase
What are the two diseases that are occur in COPD
Chronic Bronchitis (clinical) Emphysema (pathological)
What is chronic bronchitis
inflammation of large and small airways with Goblet and mucous cell hyperplasia producing lots of mucous
When is chronic bronchitis diagnosed
When patient has a sputum productive cough for at least three months out of a year for a 2 year period.
What are typical symptoms of bronchitis
Cyanotic
Overweight
Wheeze
Elevated Haemoglobin
Define Emphysema
Airspaces distal to terminal bronchiole is increased beyond normal due to destruction of their walls or dilatation. There is no obvious fibrosis
An xray of emphysema would show..
Hyperinflation
Flattened diaphragm
What are the 4 types of Emphysema
Centriacinar - effects apex of lung and found in long standing smoking. Starts at terminal bronchioles and then moves distally.
Panaciner - found basally and in people with Alpha-1 trypsin deficiency
Periaciner
Scar/irregular/Bullous - a Bulla is found in the emphysematous space. Not a problems unless bursts and causes spontaneous pneumothorax
On Auscultation, what would emphysema sound like
Quiet chest.
How can severe COPD causes Hypoxaemia? (x4)
V/Q mismatch (most common)
Diffusion impairment
Alveolar Hypoventilation
Shunt
What can happen in severe COPD
Ventilatory failure (type 1 and 2)
Cor Pulmonale
Secondary Polycythaemia
What is type 1 and type 2 ventilatory failure
type 1 - low O2 and Co2 normal or low
Type 2 - low 02 and high CO2 (hypoxic drive)
What is hypoxic drive
High levels of Co2 desensitizes the central chemoreceptors and the body relies on peripheral chemereceptors and oxygen pO2 to control breathing.
What is secondary Polycythaemia
The body produces more EPO in response to low Po2. This increases hematocrit and blood viscosity.
What are the differentials to COPD
Pneumonia
Lung cancer
Pleural Effusion
Pneumothorax
What are the non-pharmalogical managements of COPD
Smoking cessation (effects take a while)
Annual Flu and Pneumococcal vaccine (reduces hospital admissions)
Pulmonary rehab - most beneficial
Nutritional assessment (small meals)
Psychological support
Does pharmacological intervention reduce mortality
NOPE
They are used to relieve symptoms, prevent exacerbations and improve QOL
What drugs would you prescribe for COPD
Short acting Bronchodilators - SABA - salbutamol -SAMA - ipratropium Long acting bronchodilators - LAMA - tiotropium - LABA salmeterol High Dose inhaled corticosteroids -ICS
If COPD more common in males are females?
Females
What is the treatment for an acute exacerbatin
short acting bronchodilators
Steroids for 5-7 days
Antibiotics (only if a bacterial infection)
Admit to hospital if sats <92%, tachynpoea or hypotension
What significant symptoms are not usually found with COPD
Finger clubbing
Haemoptysis
Chest pain
