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Respiratory > COPD > Flashcards

COPD Flashcards

1
Q

COPD is a combination of?

A

chronic bronchitis and emphysema

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2
Q

what are the histological changes in chronic bronchitis

A

hypertrophy of mucus secreting glands and hyperplasia of goblet cells

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3
Q

which cytotoxic T cell is involved in COPD?

A

CD8 - alveolar epithelial cells

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4
Q

what is the immune response in COPD?

A

Cigarette smoke activates macrophages and airway epithelial cells which release neutrophil chemotactic factors – including IL-8 and leukotriene B4
Neutrophils and macrophages then release proteases that break down connective tissue + stimulate mucus hypersecretion

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5
Q

what is the affect of inflammation of the airway?

A

scarring and fibrosis of tissue
bronchoconstriction
epithelial cells can become ulcerated - healing with columnar cells rather than squamous cells

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6
Q

what is the mechanism of increased mucus production?

A

hypertrophy and hyperplasia of mucus glands increase mucus production = airway obstruction
irritants cause cilla shortening - hard to remove mucus

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7
Q

what are the mechanisms behind emphysema?

A

Loss of elasticity of the alveoli
Alveolar destruction and loss of bronchial support
Inflammation and scarring – reducing the size of the lumen, as well as reducing elasticity
Mucus hypersecretion.
Causes enlarged airspaces distal to the terminal bronchioles

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8
Q

Most common cause of COPD

A

smoking

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9
Q

genetic causes of COPD

A

A1-antitrypsan deficiency

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10
Q

how does A1-antitrypsan

A

Enzyme that destroys other enzymes – destroys proteases including trypsin, elastases and collagenases
If this is deficient, these enzymes eat away at lung tissue

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11
Q

clinical features of COPD (13)

A 
•	Breathlessness
•	Cough
•	Regular Exacerbations
•	Tachypnoea
•	Use of accessory muscles of respiration
•	Hyperinflation
•	reduced breath sounds?
•	Wheeze
•	Crackles (rales)
•	Hypoxemia
•	Hypercapnia
vasoconstriction, lung infections
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12
Q

what is the mechanism of hypercapnia in COPD

A

This is because the mucus flux in the airway block air flow right which causes the partial pressure of CO2 to go up in the lungs
Increases partial pressure of CO2 means that the partial pressure of O2 or oxygen in the lungs goes down and a lower PO¬2 means less oxygen gets into the blood causes hypoxemia.
This trapped CO¬2¬ also makes it harder for CO2 to get out of the bloodstream which explains the hypercapnia

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13
Q

what is the mechanism of vasoconstriction in COPD

A

Blood vessels undergo vasoconstriction in an attempt to shunt blood to an area with better exchange but when a large proportion of the lungs aren’t exchanging oxygen a large proportion of blood vessels start to constrict = increasing pulmonary vascular resistance and to maintain pulmonary blood flow the body responds by developing pulmonary hypertension

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14
Q

what feature of COPD causes increased risk of lung infection?

A

mucous plugs develop lung infections behind them

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15
Q

what organisms are common in COPD lung infections?

A

Strep pneumoniae, h.influenzae

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16
Q

what are the features of pink puffers?

A

normal PaO2, and a normal or low PaCO2
emphysema
hyperventilate to increase alveolar ventilation and keep blood gases normal
Type 1 resp failure

17
Q

what are the features of blue bloaters?

A 
low PaO2 and a high PaCO2
cyanosed but not breathless
decreased alveolar ventilation
hypoxic drive
cor pulmonale 
type 2 failure
18
Q

what are the spirometry features of COPD

A

FVC<80% predicted

FEV1/FVC<0.7, OR

19
Q

what mechanisms account for the altered spirometry

A
  • Airway become obstructed and lungs don’t empty properly, leaves air trapped in lung
  • Maximum amount of air in a single breath is known as the FVC is reduced (4L compared to 5L) – reduction more noticeable in the first second of air breathed out FEV1 (this reduction is even more than FVC, 2L compared to 4L)
  • = FEV1/FVC ratio <75%
  • TLC – air in – actually often higher because they are trapping
20
Q

what investigations should be considered for COPD?

A 
lung function tests
CXR
ECG
ABG
A1-antitrypsin test
FBC
21
Q

what features will be present in a COPD ECG?

A

large P waves

22
Q

what will the ABGs of COPD show

A

decreased PaO2 and increased PaCO2

23
Q

what can FBC in COPD show?

A

o Polycythaemia – measure the haematocrit – >45
o Normocytic normochromic anaemia of chronic disease – prevalence of up to 20%.
o HB and PCV may be raised

24
Q

what is the stage classification of COPD

A 
0 – at risk ≥80%
I – Mild ≥80%
II – Moderate 50-70%
III – Severe 30-49%
IV – very severe <30%
25
Q

what risk factors can be reduced in COPD?

A

stop smoking, encourage exercise, obesity, flu jabs, palliative care, air travel, diet (prevent unnecessary weight loss)

26
Q

how is Mild/Moderate COPD treated?

A

Inhaled long acting antimuscarinic (tiotropium) of B2 agonist

27
Q

how is severe COPD treated

A

Combination long acting B2 agonist + corticosteroids e.g. Symbicort (budesonide + formoterol) or tiotropium

28
Q

what surgical treatments can be considered for COPD

A

Bullectomy
Lung volume reduction surgery
Lung transplant

29
Q

what are the complications of COPD?

A

Respiratory failure – type 1 and type 2

Cor pulmonale

30
Q

How to treat pulmonary hypertension

A

Assess the need for LTOT

Treat oedema with diuretics (furosemide 1st line)

31
Q

what are the indications for LTOT?

A

PaO2 <7.3kPa
PaO2 <8kPa, and patient also has polycythaemia, hypoxaemia, peripheral oedema or pulmonary hypertension
FEV1 30-49% predicated
Cyanosis

32
Q

what investigatiosn are useful in exacerbation of COPD?

A 
FBC< U&amp;E, LFTs CRP
o	Consider coag, D-dimer, blood cultures
o	ABG
o	CXR
o	ECG
o	Sputum culture
o	PEFR
o	Spirometry
33
Q

what first line treatment would you consider in COPD exacerbation?

A 
Oxygen
Nebuliser - salbutamol 2.5mg, ipratropium bromide
Antibiotics
Steroids 
consider BIPAP
34
Q

what target saturations do you aim for in COPD?

A

88-92%

35
Q

what mask should you use for oxygen delivery in COPD

A

venturi mask

Respiratory (12 decks)

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