COPD Flashcards
Define COPD
Chronic obstructive pulmonary disease. Combination of 2 diseases. Emphysema and chronic bronchitis. Alveolar destruction and narrowing airways. Common and preventable
Prevalance
3 mil in UK (1mil diagnosed), requires lots of damage hence diagnosed at later age. 5% of all deaths
Causes?
Inhalation of harmul substances. Smoking cigarettes/cannabis/heroin, environmental particles
Pathophysiology? Bronchitis? Diagnosis?
Irritants in smoke: mucous gland hypertrophy, secretion, reduced clearance, increased polymorphs and fibroblasts-> strictures leading to narrowing (Bronchoconstriction ), chronic cough for more than 3 months over 2 years.
Pathophysiology? emphysema? Diagnosis?
Increased polymorphs and neutrophil elastase-> reduced area for gas exhange-> loss supporting tissue->Early expiratory collapse->Hyperinflation. Radiological diagnosis
Inflammatory response in COPD?
Smoke->chemotactic factors-> neutrophils and CD8->Activate fibroblasts, resulting in abnormal repair processes, An imbalance between proteases released from neutrophils and macrophages and antiproteases leads to alveolar wall destruction (emphysema). Proteases also cause the release of mucous
Pathological consequances?
Reduced alveolar ventilation Chronic hypoxia C hypercapnia Consequences on respiratory drive Decreased bacterial clearance Colonisation Bronchiectasis Increased pulmonary capillary resistance Pulmonary hypertension
Clinical features?
Age, (ex)smoker, breathlessness, productive cough, infections, wheezing without features from asthma
Diagnosis?
Based on features and spirometry
Prognosis?
Good if stop smoking 80% of those with mild alive in 4 years
<50 if severe ^
Staging severity using GOLD or BODE (FEV1 % predicted, 6 minute walk test, dyspnea scale, BMI)
Management?
Healthy life style (lose weight, exercise, eat well, stop smoking), support (group, 1:1). Steroids + Antibiotics + Nebulisers + Ventilatory support
Beware of oxygen
Exarcebation?
Cough
Worsening breathlessness
Increased sputum production
Change in sputum colour
Fundamental of COPD care?
Treatment and support to stop smoking
Flu vaccinations
Pulmonary rehabilitation
Co-develope personalised self-management program
Optimise treatment for comordbidities
Inhaled therapies after (nebulisers, long-term oxygen)
Systemic effects of COPD?
Cor pulmonale (right sided heart failure) Increased risk of CVD Anxiety and depression Nutrition - metabolic diseases Bone diseases
Why patients lose weight?
GI distress- not eating much
Increased metabolic rate (inflammation, hypoxia)
Breathlessness
