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Year 3: respiratory conditions > COPD > Flashcards

COPD Flashcards

1
Q

define COPD?

A

chronic progressive lung disorder characterized by airflow obstruction often accompanied with chronic bronchitis and emphysema

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2
Q

what is chronic bronchitis?

A
  • chronic cough and sputum production on most days for at least 3 months per year for over 2 consecutive years
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3
Q

what is emphysema?

A
  • pathological diagnosis of permanent destructive enlargement of air spaces distal to the terminal bronchioles.
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4
Q

what is the aetiology of COPD?

A

two main causes: environmental damage and a-antitrypsin deficiency.

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5
Q

how does environmental damage cause COPD?

A

environmental toxins such as cigarette smoke can cause bronchial and alveolar damage.
this is common

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6
Q

when should 1antitrypsin deficiencybe considered?

A

in young patients who have never smoked before and present with COPD type symptoms

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7
Q

what is the pathophysiology of chronic bronchitis?

A
  • the narrowing of the airways results in bronchiole inflammation, bronchial mucosal oedema, mucous hyper-secretion and squamous cell metaplasia
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8
Q

what is the pathophysiology of emphysema?

A
  • it is the destruction and enlargment of the alveoli
  • it leads to loss of elasticity which keeps the airways open in expiration
  • larger spaces keep developing they are called bullae
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9
Q

epidemiology of COPD?

A
  • it is really common
  • presents in the middle age
  • more common in males
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10
Q

presenting symptoms of COPD?

A
  • chronic cough
  • sputum production
  • breathlessness
  • wheeze
  • reduced exercise tolerance
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11
Q

what are the signs of COPD on examination?

inspection

A
  • respiratory distress
  • use of accessory muscles
  • barrel shaped over-inflated chest
  • decreased cricosternal distance
  • cyanosis
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12
Q

what are the signs of COPD on examination?

percussion

A
  • hyper-resonant chest

- loss of liver and cardiac dullness

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13
Q

what are the signs of COPD on examination?

auscultation

A
  • quiet breath sounds
  • prolonged expiration
  • wheeze
  • rhonchi
  • crepitations
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14
Q

what is rhonchi?

A
  • it is rattling, continuous and low pitched breath sounds that sound like snoring
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15
Q

what are early signs of CO2 retention?

A
  • bounding pulse
  • warm peripheries
  • asterixis
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16
Q

what are late signs of CO2 retention?

A
  • cor pulmonale signs
  • right ventricular heave
  • raised JVP
  • ankle oedema
17
Q

what investigations should be carried out for COPD?

A
  • spirometry
  • CXR
  • bloods
  • ECG
  • sputum and blood cultures
  • a-antitrypsin levels
18
Q

what might spirometry show?

A
  • will show reduced PEFR
  • will show reduced FEV1
  • increased lung volumes
19
Q

what might the CXR show?

A
  • it may appear normal
  • could show hyperinflation
  • there are reduced peripheral lung markings
20
Q

what might the bloods show?

A
  • the FBC will show increased Hb and haematocrit
  • this is due to secondary polycythaemia
  • an ABG can show hypoxia
21
Q

what might the ecg show?

A
  • cor pulmonale
22
Q

what might the sputum and blood cultures show?

A
  • these are useful in acute infective exacerbations
23
Q

what might measuring the x antitrypsin levels show?

A
  • useful in checking in checking young patients who have never previously smoked
24
Q

what is the overall management plan for COPD?

A
  • stop smoking
  • bronchodilators
  • steroids
  • pulmonary rehabilitation
  • oxygen therapy
25
Q

which bronchodilators should be used?

A
  • short acting beta 2 agonists
  • anticholinergics
  • long acting beta 2 agonists
26
Q

which steroids should be used?

A
  • Inhaled beclamethasone
    this should be considered in all patients with an FEV1 <50% or greater than 2 exacerbations each year
  • steroids should be avoided
27
Q

when should oxygen therapy be used?

A
  • if the patient has stopped smoking
28
Q

when is oxygen therapy indicated?|

A
  • when the PaO2 < 7.3 kPa on air during a period of clinical stability
  • OR when PaO2 is between 7.3 - 8 but there are signs of secondary polycythemia or nocturnal hypoxaemia, peripheral oedema or pulmonary hypertension.
29
Q

how should acute exacerbations be treated?

A
  • 24% oxygen via a venturi mask
  • percentage to be increased if there is hypoxia persists and there is no hypercapnia
  • start antibiotics therapy if there is infection
  • non invasive ventilation is sometimes necessary
  • prevention of infective exacerbations using vaccines
30
Q

what are the complications of COPD?

A
  • acute respiratory failure
  • infection
  • pulmonary hypertension
  • right heart failure
  • pneumothorax (when the bullae rupture)
  • secondary polycythaemia
31
Q

what is the prognosis of patients with COPD?

A
  • high morbidity
  • 3 year survival of 90% if <60 and FEV1>50
  • 3 year survival of 75 if >60 and FEV 40-49

Year 3: respiratory conditions (16 decks)

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