COPD & Acute COPD (Pathology) Flashcards
What is COPD
Chronic obstruction to lung airflow that interferes with normal breathing & NOT fully reversible + progressive
What is chronic bronchitis?
cough productive of sputum most days in at least 3 consecutive months for 2 or more consecutive years
- Large airways: mucus gland & goblet cell hyperplasia
- Small airways: goblet cells+ inflammation & fibrosis
What is emphysema?
increase beyond the normal size of airspaces distal to terminal bronchiole arising from dilatation or destruction of their walls w/out fibrosis —> loss of alveolar attachments
Leads to: ↓↓anti elastase= lost homeostasis= tissue destruction
What is centriacinar emphysema?
Start with bronchiolar dilatation- upper zones
What is panacinar emphysema?
in alpha1 antitrypsin deficiency (basal emphysema) & heavy smokers (upper zone)
What is periacinar emphysema?
periphery-> spontaneous pneumothorax
Risk factors/causes of COPD (10)?
- SMOKING
- Atmospheric pollution
- Occupation dust
- Alpha 1 antitrypsin deficiency – early onset <45 y.o.
- Age
- Female
- Lower socio-economic status
- Asthma/airway hypersensitivity
- Chronic bronchitis
- Childhood infection
Symptoms of COPD (8)
• Breathlessness • Cough +/- sputum • Frequent chest infections • Wheezing • Weight loss • Fatigue • Swollen ankles • Cardiac disease Chronic hypoxia - Pulmonary arteriolar vasoconstriction —> ↑ pulmonary hypertension = RV hypertrophy
Signs of COPD (8)
- Cyanosis
- Raised JVP
- Cachexia
- Wheeze
- Pursed lip breathing
- Hyperinflated chest (Barrel chest- pectus excavatum)
- Use of accessory muscles
- Peripheral oedema
What are the 5 stages (0-4) of the mMRC breathlessness scale?
0: i only get breathless with strenuous exercise
1: i get short of breath when hurrying on ground level or walking up a slight hill
2: on level ground, i walk slower than people of the same age because of breathlessness, or have to stop for breath when walking at my own pace
3: i stop for breath after walking about 100 yards or after a few minutes on level ground
4: i am too breathless to leave the house or i am too breathless when dressing
What are the symptoms/signs of severe COPD?
Hypoxic drive-> rely on central chemoreceptors
Cor pulmonale:
- chronic hypoxia-> arteriolar vasoconstriction-> pulmonary hypertension-> RV hypertrophy-> LHF-> RAAS - leg swelling + oedema + ↑ JVP, congested liver
Chronic polycythaemia – response to chronic hypoxia
- ↑erythropoietin= ↑Hb= ↑viscosity
What criteria need met to diagnose COPD?
Diagnose COPD if meets ALL these criteria
- Typical symptoms
- > 35 y.o.
- Risk factors
- No asthma clinical features
AND
airflow obstruction confirmed by post-bronchodilator spirometry -> lack of reversibility (< 70%)
- Stage 1-FEV1 80% only diagnose if resp symptoms
- Stage 2 50-79%
- Stage 3 30-49%
- Stage 4 < 30%
What would spirometry in COPD look like? which co-morbidity may mask COPD?
- Obstructive
- FEV1 ↓↓
- FVC normal or ↓
- ↓Ratio
- Obesity- restrictive spirometry- mask COPD
Why would you do a CXR for COPD? What would COPD CXR look like?
exclude other pathology, malignancy
- hyperinflated lungs
- > 6 ribs anteriorly, 10 ribs posteriorly
- suspended small heart
- flat diaphragm
- bulla & vascular hila
What is the non-pharmacological management of COPD (5)?
- smoking cessation
- vaccination (flu yearly + pneumococcal every 5 years)
- pulmonary rehab
- nutritional assessment
- psychological support
