COPD Flashcards
Management
Vaccinations
Stop smoking
Pulmonary rehab
Steroid inhalers
Which vaccinations would you recommend?
Pneumococcal
Flu
Pathophysiology
Shit from cigarette smoke activate macrophages
Neutrophil activation
Antiprotease produced more
Antioxidants produced less
Drives increased mucus production and epithelial cell injury
Leads to emphysema and chronic bronchitis
Where do long acting beta agonists work?
B2 receptor on muscle
Note: there is no direct sympathetic activation of the lungs, it’s indirect via adrenaline
Where do long acting muscarinic antagonists work?
Acetylcholine normally induces constriction, so blocks this and ALSO blocks mucus production
Name some Non-adrenergic, non-cholinergic
Substance P
Vasal intestinal peptide
How do steroids work?
Interfere with activation of neutrophils.
First line prescription
1x Salbutamol, 100mcg/puff inhaler
Inhale 2 puffs as needed, maximum 2 puffs four times per day
Second line?
If short acting doesn’t work, you try LABA or LAMA
When do you include ICS steroid as second line and what do you include it with?
If they are asthmatic, with LABA
What is the end stage support?
Triple therapy
What if someone came back with hypertension?
Send them for ABPM
What is COPD?
An irreversible obstructive lung disease
What two conditions form COPD?
Chronic bronchitis
Emphysema
What is chronic bronchitis?
This is where inflammation of the bronchial walls causes hypertrophy and hyperplasia of the mucosa of the bronchioles, including goblet cells. Therefore you also get increased mucus production and hence the productive cough.
Give some signs of chronic bronchitis
Signs: Hypoxemia Hypercapnia Wheeze (narrowing of vessel walls) Productive cough Crackles Rales
What PFTs are seen in COPD?
Air can't get OUT therefore: Low FEV1 Low FVC Low ratio of FEV1 to FVC Residual volume is increased
What are the three types of emphysema?
Centriacinar / centrilobular emphysema
Panacinar paraseptal
Paraseptal emphysema
Where do you get centriacinar emphysema and which group of patients typically get this?
Affects proximal alveoli of an acinus (cluster of alveoli)
Mainly in upper lobes of the lungs, in smokers
Where do you get panacinar emphysema and which group of patients typically get this?
Affects all aspects of acinus, usually in lower lobes and associated with alpha-1 antitripsin deficiency
What is paraseptal emphysema?
Affects distal alveoli of acinus, especially in lung peripheries on between lobes (hence interseptal)
What is emphysema?
This is where the elasticity of the alveoli breaks down as a result of neutrophils releasing elastase. This leads to chronic widening of the alveoli
What is the chest shape of someone with emphysema, and why?
Barrel chest due to hyperinflation
What symptoms would someone with emphysema present with?
Shortness of breath
When can you diagnose chronic bronchitis?
Based on a productive cough that lasts for at least 3 months, and over a period of 2 or more years.
Do you get bronchiectasis or atelectasis in COPD?
Atelectasis - alveolar collapse
Note: bronchiectasis is seen in chronic infection/inflammation of the lungs, resulting in widening of the bronchi
