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Respiratory Medicine > COPD > Flashcards

COPD Flashcards

1
Q

What is normal FEV1??

A

70-80% of FVC (3.5-4L)

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2
Q

What is normal FVC?

A

5L

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3
Q

What is the normal FEV1/FVC ratio?

A

0.7-0.8L

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4
Q

What happens to FEV1/FVC in obstructive lung disorders such as COPD?

A

FEV1 is reduced
FVC may be reduced
FEV1/FVC is <0.7

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5
Q

What is the normal peak expiratory flow rate?

A

400-600L/min

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6
Q

What happens to peak expiratory flow rate in obstructive conditions?

A

It is reduced

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7
Q

What is the clinical definition of chronic bronchitis?

A

Cough productive of sputum most days in at least 3 consecutive months for 2 or more consecutive years (without presence of TB, bronchiectasis etc)

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8
Q

What condition is chronic bronchitis most often confused with?

A

Chronic bronchial asthma

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9
Q

What two things clinically define COMPLICATED chronic bronchitis?

A

Mucopurulent sputum or a fall in FEV1

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10
Q

List the three large airway changes that occur in chronic bronchitis

A
  • Mucous gland hyperplasia
  • Goblet cell hyperplasia
  • Inflammation and fibrosis is a minor component
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11
Q

Lit the two small airway changes that occur in chronic bronchitis

A
  • Goblet cells appear in places where there should be no goblet cells
  • Inflammation and fibrosis in long standing disease
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12
Q

What is the pathological definition of emphysema?

A

An abnormal increase in the size of airspaces distal to the terminal bronchiole arising either from dilatation or from destruction of their walls and without obvious fibrosis.

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13
Q

What is included in an acinus

A

Everything distal to the terminal bronchiole (the “bunch of grapes” made from branches of alveoli)

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14
Q

What causes the increase in the air spaces as seen in emphysema?

A

the loss of the elastic tissue in alveolar walls

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15
Q

Name the 5 types of emphysema and identify the most common type

A
  1. Centriacinar 9most common)
  2. Panacinar
  3. Periacinar
  4. Scar ‘ irregular’
  5. ‘Bullous emphysema’
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16
Q

What is centriacinar emphysema?

A

The loss of lung tissue is concentrated around the middle of the acinus causing a hole in the middle of the acinus.

This means that you end up with holes in the lung tissue surrounded by lung tissue

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17
Q

Which regions of the lung tend to be worst affected by centriacinar emphysema?

A

the upper sections (gough-wentworth sections)

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18
Q

Describe what happens in panacinarf emphysema

A

Degradation of large sections of the lung rather than small holes as in Centriacinar
The gas exchange tissue is completely lost leaving only blood vessels and bronchioles

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19
Q

Describe what happens in periacinar emphysema

A

Tissue is lost from around the bottom edge of the acinar

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20
Q

Where in the lungs is periacinar emphysema seen?

A

particularly prevalent in acinar around the closest to the pleura

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21
Q

Why is emphysema close to the pleura clinically dangerous?

A

air can leak into the space between the lung and the pleura (pleural space) and a pneumothorax can occur

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22
Q

What is scar emphysema?

A

Scar emphysema is not clinically significant and simply refers to the formation of scars around regions of emphysema in the lung

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23
Q

How many ribs is it normal to see on an x-ray?

A

9-10

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24
Q

What x-ray findings are associated with emphysema?

A

Hyperinflation

all posterior ribs visible and the heart appears suspended in the middle of the lung field

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25
Q

What finding may you see on a CT scan that could indicate emphysema?

A

“bubbling” caused by emphysemic air sacs

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26
Q

What is the pathological cause of emphysema?

A

protease-antiprotease imbalance

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27
Q

name three things that can cause a protease-antiprotease imbalance

A
  1. SMOKING*
  2. Ageing (to a lesser extent than smoking)
  3. Alpha-1-antitrypsin deficiency (genetic cause)
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28
Q

Explain how the elastic framework of a healthy individual is maintained

A
  1. residual inflammatory cells release elastase while they digest pathogens/foreign material
  2. Elastase (which breaks down elastin) is broken down by anti-elastase produced by the lung
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29
Q

Explain the pathological process behind emphysema caused by smoking

A
  • Increased presence of neutrophils and macrophages in response to the cigarette smoke in the lungs
  • The presence of more inflammatory cells causes an increase in elastase production
  • Smoking dampens the bodies (already limited) lung repair mechanisms and elastin synthesis
  • Anti-elastase is inhibited by cigarette smoke so elastase is not removed.
30
Q

what causes the collapse of small airways (and the subsequent trapping of air) in emphysema?

A

The tiny airways in the lungs will collapse if the alveoli do not have radial pull from the elastic alveoli (think of it like guy ropes holding up a tent).

31
Q

What 4 things cause hypoxaemia in COPD?

A
  • Airway obstruction
  • Reduced respiratory drive
  • Loss of alveolar surface area
  • Shunting
32
Q

Explain how emphysema causes cor pulmonale (right heart failure)

A

Vessels constrict to shunt blood away from poorly ventilated regions

In emphysema, poor ventilation is widespread- thus there is widespread constriction of blood vessels

This widespread constriction causes high pressure in the pulmonary system

chronic pulmonary hypertension causes hypertrophy of the right ventricle because the heart is having to work harder to overcome the resistance in the lungs caused by the vessel constriction

33
Q

What is the difference between incidence and prevalence?

A 
Incidence= the number of new cases being diagnosed within a defined period of time
prevalence= the number of cases within a population at any given point of time
34
Q

What are the 2 most common lung diseases?

A
  1. Asthma

2. COPD

35
Q

What % of the UK population has COPD?

36
Q

What % of COPD cases are under diagnosed?

37
Q

What is currently happening to the prevalence and incidence of COPD?

A

Prevalence is increasing but incidence is decreasing.

38
Q

List 3 clinical indicators of Alpha-1 Antitrypsin Deficiency

A
  1. COPD features in a young patient
  2. Emphysema in the basal aspect of the lung (usually it is in the apex)
  3. Liver fibrosis or cirrhosis
39
Q

What % of smokers develop COPD?

40
Q

Name the graph that can be used to demonstrate the positive impact of smoking cessation even in long term smokers

A

Fletcher-Peto Curve

41
Q

List 5 common symptoms of COPD and three other symptoms of COPD

A
  1. Cough
  2. Breathlessness
  3. Sputum
  4. Frequent chest infections
  5. Wheezing
  6. Weight loss
  7. Fatigue
  8. Wheezing
42
Q

There are 9 clinical findings which can indicate COPD. List them

A
  1. Breathless when walking into the consultation
  2. Cyanosed
  3. Chest wall deformities (e.g. barrel chest- hyperinflation)
  4. Use of accessory muscles when breathing
  5. Peripheral oedema
  6. Pursed lip breathing
  7. Cachexia (severe weight loss)
  8. Raised Jugular Venous Pressure
  9. Wheeze on expiration
43
Q

Name the scale used to assess breathlessness

A

Modified medical research council breathlessness scale

44
Q

What is a 0 on the mMRC breathlessness scale?

A

I only get breathless with strenuous exercise

45
Q

What is a 1 on the mMRC breathlessness scale?

A

I only get short of breath when hurrying on ground level or walking up a slight hill

46
Q

What is a 2 on the mMRC breathlessness scale?

A

On ground level, I walk slower than people of the same age because of breathlessness or I have to stop for breath when walking at my own pace

47
Q

What is a 3 on the mMRC breathlessness scale?

A

I stop for breath after walking about 100 years or after a few minutes on ground level

48
Q

What is a 4 on the mMRC breathlessness scale?

A

I am too breathless to leave the house or I am breathless when dressing

49
Q

What is used to diagnose COPD?

A

History and examination findings

50
Q

what criteria would give a definitive COPD diagnosis? (5)

A
  1. Typical symptoms
  2. > 35 years
  3. Presence of risk factor (smoking or occupational exposure)
  4. Absence of clinical features of asthma
  5. AND Airflow obstruction confirmed by post-bronchodilator spirometry
51
Q

What FEV1 values are associated with mild, moderate, severe & very severe COPD?

A

Mild= FEV1 80% of predicted value or higher

Moderate= 50–79% of predicted value

Severe= 30–49% of predicted value.

Very Severe= less than 30% of predicted value.

52
Q

How can obesity complicate a COPD diagnosis?

A

besity can cause restrictive airflow disorders and raise the FEV1/FVC ratio masking classic COPD spirometry

53
Q

Do COPD symptoms typically vary between day and night?

54
Q

What should a clinician do if they are unsure of a COPD diagnosis following spirometry and peak expiratory flow?

A

Pulmonary function tests

High resolution CT (look for signs of emphysema)

55
Q

What CT findings are indicative of emphysema?

A 
Signet ring sign 
Honeycombing 
Traction bronchiectasis 
Lung cysts 
Centrilobular emphysema
56
Q

Which 5 symptoms would you expect to worsen in an acute exacerbation of COPD?

A
  • SOB
  • Wheeze
  • Chest tightness
  • Cough
  • Sputum – purulence / volume
57
Q

What would you expect the respiratory rate to be in a severe exacerbation of COPD?

58
Q

What investigations would you carry out in secondary care in an acute exacerbation of COPD? (6)

A
  1. Chest x-ray (CXR)
  2. blood gases
  3. Full blood count (FBC)
  4. Kidney Function tests (U&E)
  5. sputum culture
  6. Viral throat swab (VTS)
59
Q

How would you treat an acute exacerbation of COPD in secondary care?

A
  1. Oxygen (aim for sats of 88-92%)
  2. Nebulised bronchodilator (beta2 & anti-muscarinic)
  3. Oral/IV corticosteroid
  4. antibiotic if exacerbation is infective
60
Q

Name the test that can be used to assess the severity of COPD

A

The COPD assessment test

61
Q

What is the disease endpoint of COPD?

A

Respiratory failure

62
Q

What causes respiratory failure?

A

Matched but reduced V/Q

63
Q

Explain how COPD causes respiratory failure

A

Bronchioles are hypertrophied, narrowed, inflamed and filled with mucus which reduces the amount of oxygen that can reach the alveoli= REDUCED VENTILATION

The emphysema destroys the alveoli and reduces the perfusion = REDUCED PERFUSION

64
Q

List 3 clinical features of CO2 retention

A
  1. Drowsiness
  2. Flapping tremor
  3. Acidosis
65
Q

What is secondary polycythaemia?

A

body produces an increased amount of erythropoietin in response to low O2

66
Q

What is the most important thing that patients can do to slow the progression of COPD?

A

Stop smoking!

67
Q

List 5 non-pharmacological measures which can be put in place to manage COPD

A
  1. Stop smoking
  2. Vaccinate (flu and pneumococcal)
  3. Pulmonary rehabilitation
  4. Nutritional assessment
  5. Psychological support
68
Q

List the inhalers that you would prescribe to a COPD patient who is predominantly breathless without exacerbations

A

SABA (daily)

if symptoms persist

then SABA + LAMA

if symptoms persist

then SABA + LAMA/LABA combination

69
Q

List the inhalers that you would prescribe to a COPD patient who suffers from exacerbations with or without breathlessness

A

SABA + LAMA

if symptoms persist

then SABA + LAMA/LABA combination

if exacerbations continue and FEV1<50% , review

70
Q

What are the criteria that a patient must meet in order to be offered long term oxygen therapy?

A

Must have stopped smoking for at least 6 months

They must be hypoxic when they are not suffering an exacerbation; PaO2 < 7.3 kPa (or PaO2 7.3-8 if the patient has;
polycythaemia, nocturnal hypoxia, peripheral oedema or pulmonary hypertension)

71
Q

What is the most common cause of a COPD exacerbation?

72
Q

What is used to stabilise patient in acute respiratory failure?

A

Non-invasive ventilation

Respiratory Medicine (27 decks)

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