COPD Flashcards
What is COPD
Preventable and treatable disease characterised by persistent, progressive airflow limitation (not fully reversible)
Enhanced chronic inflammatory responses in the lungs to noxious gases/particles
What results from COPD
Hospital admissions, economic burden and rising prevalence due to aging population
How does COPD occur
tobacco smoking > chronic bronchitis > emphysema > airflow obstruction > COPD
Airflow narrowing due to chronic irritation of the bronchi causing inflammation and changes due to mucocilliary escalator, often results in chronic cough
Can also narrow due to bronchoconstriction and inflammation, duration and severity are risk factors for development of airway remodelling and COPD
Airways collapse due to destruction of alveolar walls – may lead to bullae
how do airways change in COPD
Airways
Chronic inflammation
Increased no of goblet cells
Mucus cell hyperplasia
Fibrosis
Narrowing and reduction in the number of small airways
Airway collapse due to alveolar wall destruction in emphysema
What are signs of COPD
Chronic bronchitis (large airways) – chronic productive cough got 3 months in two successive years, exclude other causes of cough Emphysema (alveolar) – abnormal and permanent enlargement of airspaces due to destruction of the alveolar airspace walls, effects gas exchange Small airways disease – wheeze
What are COPD risk factors
Cigarette smoke Occupational dust and chemicals Environmental tobacco smoke (ETS) Indoor and outdoor pollution Also genes, infections, socio-economic status Aging population
how can smoking history be taken
Age started
Calculate pack year history
Times stopped and why failed quit attempt
what does COPD result in
COPD > exercise limitation > dyspnoea > cough and sputum production > exacerbations > reduced QoL > Respiratory failure and increased mortality
how is COPD diagnosed
Symptoms (exertional breathlessness, productive cough, winter bronchitis, wheeze) + risk factors (10pkyr smoking history and age >35 years) + spirometry (FEV1/FVC<0.7) - obstruction
what is the MRC dyspnoea scale for COPD patients
1 not troubled by breathlessness except on vigorous exertion
2 SOB when hurrying or walking up inclines
3 Walks slow than contemporaries bc of breathlessness or has to stop at own pace
4 stops for breath after 100m or stops after a few mins on the level
5 too breathless to leave house or dressing/undressing
what are the physical signs of COPD
Barrel-shaped chest Hyperresonant percussion Accessory muscles Prolonged expiration Pursed-lip breathing Tripod position – palms flat on thighs Low BMI Nicotine staining
Physiological effects of COPD
Increased work of breathing
Reduced exercise tolerance
Impaired gas exchange (hypoxia, hypercalcaemia, raised pulmonary artery pressure, RV dilation, cor pulmonae – right heart failure secondary to respiratory disease)
Loss of fat free mass
Chronic disease management
Stop smoking If symptomatic LABA/LAMA combined inhaler Lots of inhalers Flu vaccination Education and empower Treat exacerbations Pulmonary rehabilitation Whole patient (bones, nutrition, mental health) LTOT
Pulmonary rehabilitation
2x supervised sessions for 6 weeks
Supervised exercise
Education
Psychosocial support/group work
Other treatments for COPD
Theophylline (oral phosphodiesterase inhibitor)
Azithromycin 3x a week (anti inflammatory antibiotic prophylaxis)
Lung volume reduction surgery(valves/bullectomy)
Lung transplantation
