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Year 3 > COPD > Flashcards

COPD Flashcards

1
Q

What is COPD?

A

Chronic Obstructive Pulmonary Disease

reatable( but not curable) chronic condition that is characterised by persistent resp symptoms and air flow restriction

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2
Q

What is the epidemiology of COPD?

A
  • Data might underestimate
  • 4th leading cause of death worldwide
  • Prevalence 147 million worldwide, generally very common
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3
Q

What is the Aetiology of COPD?

A
  • Smoking –> increases irritation of the airway and triggers inflammatory response
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4
Q

What are the risk factors for the development of COPD?

A
  • Smoking
  • Occupational exposure (dust fumes and chemicals)
  • Air pollution (e.g. burning coal inside)
  • Genetic
    • alpha1-antitrypsin deficiency.
  • Asthma
  • Congenital abnormal lung development
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5
Q

How does choronic airway irritation lead to airway damage in COPD?

A

Leads to

  • attraction of inflammatory cells that secrete damaging things (e.g. Elastase (Neutrophils), Metalloproteases + Oxidants (Macrophages)
    *
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6
Q

Which parts of the airway are affected by COPD?

A
  1. Chronic bronchitis
  2. Small airway fibrosis (<2mm)
  3. Emphysema in alveoli
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7
Q

What does chronic Bronchitis in COPD lead to?

A
  1. Overproduction of mucus
  2. Goblet cell hyperplasia
  3. Hypertrophy of submucosal gland
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8
Q

What does Small airway fibrosis in COPD lead to?

A
  • Small airwasy collapse
  • Become obstructed and stonsed due to fibrosis
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9
Q

What does emphysema in COPD lead to?

A
  • Break down of elastiv tissue port of alveoli
  • Increased air space, decreased tissue leading to decrease in gas exchanging surface area
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10
Q

What are the presenting symptoms of COPD?

A
  • Chronic productive cought with clear or white sputum
    • due to chronic bronchitis >3/12 for >2years
  • Exertional SOB progressively worse
  • Frequent Lower resp. tract infection
  • Weight loss, anorexia, fatigue
  • Due to hypoxia and increased effort to breath
  • Chest tightness, wheezing
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11
Q

What are signs of COPD on examination?

A
  • Cyanosis
  • Hyperinflation
    • Barrel chest
    • Hyperresonance
    • Decreased crico-sternal distance and expansion
    • Quiet breath sounds
  • Wheezing and basal crackels on auscultation
  • Raised JVP (cor pulmonale)
  • Pursed lip expiration
  • Kachexia
  • Ankle oedema
  • Normally no haemoptysis and chest pain
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12
Q

What are the investigations you would do in a Patient with suspected COPD ?

A
  • Spirometry
  • CXR
  • FBC (exclude anaemia of chronic disease)
  • Heart
    • BNP and ECG if suspected cor pulmonale
  • Consider alpha-1 antitrypsin deficiency screening if COPD, young, no risk factors
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13
Q

What are the findings of Spirometry you would expect in a patient with COPD?

A
  • Post-bronchodilator spirometry with FEV1/FVC <0.7
  • reduced FEV and FEV1 with decreased FEV1/FEC ratio
  • FEV1/FVC ration is used to determine GOLD stadium
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14
Q

What is a typical ECG of a pateint with Cor Pulmonale?

A
  • Left shift
  • right atrial and ventricular hypertrophy
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15
Q

Which findings would you expect on a CXR from a COPD patient?

A
  • Hperinflation
  • Flat hemidiaphragms, Large ventral pulmonary, arteries, decreased peripheral vascular markings, Bullar
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16
Q

What are possible complications of a patient with COPD?

A
  • Reduced quality of life
    • Acute exacerbations
  • Cor pulmonale
  • Frequent chest infection and ? Hospital admission
  • Secondary Polycythaemia
  • Resp failure
  • Pneumothorax (if empyhsema ruptures)
17
Q

What is the conservative management for COPD patients?

A
  • Smoking cessation
  • Pulmonary rehabilitation (tendency about more severe cases)
  • Vaccination
    • Influenza
    • Pneumococcal
  • Physiotherapy and Occupational Therapy
  • Dietetic advise
  • Psychology (if co-exiting mental health problems)
18
Q

What is the medical management of Patients with COPD?

A
  • Oxygen (if sats <88%, aim for 92%)
  • SABA or SAMA (Short acting muscarinic antagonist
  • If not work: LABA and LAMA
  • If still no improvement: LABA + LAMA + ICS
  • Long-term ABX to decrease risk of infection
19
Q

When would you consider specialist referral for a Patient with COPD?

A
  • Diagnostic uncertainty
  • Severe COPD (<30% FEV1)
  • >2 exacerbationn in one year
  • Significant sputum burden
  • Age <40 a1antit-deficienc<
  • Sats <92%
  • Weight loss of haemoptysis via 2 WW referal
20
Q

What is the prognosis of a patient with COPD?

A
  • Generally gradual decline with progressive loss of lung function
  • Generally worse with
21
Q

What are worse prognostic factors in COPD patients?

A
  • Low FEV1
  • Smoking
  • Severer symptoms and burden
  • Muscle wasting and low weight
  • Increased hospital admission due to exacerbation
  • Multimorbidity and frailty
22
Q

What are the effects of LAMAs in COPD?

A

= Long acting muscarenic antagonis

  • decreased mucus production
  • airway dilation (decreased Smooth Airway muscle constriction)

Year 3 (52 decks)

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