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COPD, acute exacerbation Flashcards

1
Q

define COPD?

A

progressive and irreversible obstructive airway disease

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2
Q

which two diseases fall under the umbrella of COPD?

A

emphysema and chronic bronchitis

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3
Q

is asthma part of COPD?

A

no

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4
Q

is COPD progressive?

A

yes

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5
Q

is COPD reversible or irrerversible?

A

irreversible

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6
Q

if an enzyme is a protease, what exactly does it do?

A

proteolysis; breaks down protein

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7
Q

elastase is what type of enzyme?

A

protesase

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8
Q

what protein does elastase break down?

A

elastin

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9
Q

which molecule counteracts elastase?

A

alpha-1-antytripsin

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10
Q

what class of molecule is alpha-1-antytripsin?

A

anti-protease

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11
Q

Emphysema is an imbalance between what proteins?

which protein is greater?

what effect does this have on lung tissue

A

elastase > alpha-1-antitrypsin

elastin broken down

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12
Q

how does elastin broken down in emphysema change alveoli?

A

fewer, larger alveoli

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13
Q

how does elastin broken down in emphysema change the passive part of exhaling?

how will this change the shape of the lungs? and shape of ribcage?

how will this look on CXR

A

lung can not recoil.

lungs stay hyperinflated,
rib cage expanded

CXR: big lungs with lots of black (air)

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14
Q

which epithet is used to describe emphysema patients?

A

pink puffers

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15
Q

which epithet is used to describe chronic bronchitis patients?

A

blue bloaters

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16
Q

Who and why are they called pink puffers?

A

emphysema

pink - skin is pink early on, (blue in later stages).

puffers - pursed lip breathing

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17
Q

Who and why are they called blue bloaters?

A

chronic bronchitis

blue skin

bloaters - fat

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18
Q

someone has pure emphysema, what are the classical characteristics they will show?
- 4 in total

A

pink skin
pursed lip breathing
muscle wasting
barrel chest

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19
Q

what happens to cilia in chronic bronchitis?

A

paralysed

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20
Q

define chronic bronchitis?

A

mucus hypersecretion secondary to ciliary paralysis

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21
Q

what is the obstruction in chronic bronchitis?

A

mucus in airways

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22
Q

in chronic bronchitis how will the histology look of the goblet cells,

what is the function of the goblet cells?

A

goblet cell hypertrophy and hyperplasia

make mucus

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23
Q

how exactly does smoking cause emphysema

A

smoking –>macrophage + neutrophils activated –> these make ↑elastase –> destroys alveoli (emphysema)

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24
Q

what does smoking do to mucus production?

A

mucus hypersecretion

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25
Q

Risk factors for COPD

- 5 things

A 
Age 
Smoking
Air pollution 
Occupation exposure 
A1AT deficiency – younger diagnosis
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26
Q

why is it that anything causing chronic inflammation of lungs can give you COPD and not just smoking?

aside from smoking what else can cause chronic lung inflammation?
- 2 things

A

lung inflammation –> macrophages + neutrophils activated –> these cells make proteases –> protease destroys harmful stuff & also healthy tissue.

but if chronically inflamed you will get chronic ↑ proteases –> chronic damage of healthy tissue –> COPD

air pollution 
occupation exposure (asbestos)
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27
Q

Complications of COPD?

- 5 things

A 
Acute exacerbation 
Cor pulmonale 
Type 1 or 2 resp failure 
Secondary polycythaemia 
Pneumothorax
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28
Q

what is essentially the underlying cause of COPD

A

chronic inflammation of lungs

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29
Q

what is the pathway for how COPD causes cor pulmonale?

A

Severe COPD –> Pulmonary HTN –> R. Sided heart failure, i.e. cor pulmonale.

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30
Q

define cor pulmonale?

A

right sided haeart failure due to lung disease

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31
Q

how does COPD cause pulmonary HTN?

- give step by step pathway

A

COPD –> hypoxia in lungs –> vasculature remodels + lose capillaries in emphysema –> pulmonary HTN

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32
Q

what effect does emphysema have on capillaries in lungs?

A

lose capillaries

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33
Q

define polycythaemia?

A

↑[RBC] in blood

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34
Q

why is there secondary polycythaemia in COPD?

A

compensation for chronic hypoxia

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35
Q

someone has COPD,

on auscultation what do you classically hear?

and why?

A

wheeze

narrowed airways (mucus filled) & fewer alveoli.

36
Q

symptoms of COPD

- 3 things

A

SOB
Productive cough
Wheeze

37
Q

signs of COPD
-6 things

explain why you get each one?

A

Tachypnoea – SOB

Barrel chest – air in lungs, rib cage expanded

Hyperresonance on percussion – air in lungs

Wheeze – narrow airway

Tar staining – smoking

Peripheral cyanosis – chronic hypoxia

38
Q

GOLD.S IX for COPD?

What is a positive result?

A

Spirometry and bronchodilator reversibility

FEV1/FVC < 0.70 and no reversibility post-bronchodilator is +ive result

39
Q

what is the FEV1/FVC ratio for obstructive lung disease?

A

FEV1/FVC < 0.70

40
Q

what is GOLD.S IX for COPD?

asides from the gold.S Ix what other Ix will you do for a pt suspected of COPD and what are you looking for/why do you do this?
- 3 IX

A

Spirometry and bronchodilator reversibility

CXR – flat diaphragm, hyperinflation and bullae.
check lung cancer

FBC – polycythaemia

BMI - weight changes in COPD

41
Q

what does Serum A1AT look for?

when would this be indicated in a pt with COPD, what are you looking for?

A

alpha-1-antytripsin

if symptoms are early onset, or no smoking history, alpha-1-antytripsin
inherited disorder

42
Q

alpha-1-antytripsin deficiency is a non-inherited disorder.

true or false?

A

false

43
Q

very young pt who has never smoked has COPD symptoms, grandfather had the same problem

what could be the cause of their COPD?

which Ix will help diagnose this?

A

alpha-1-antytripsin deficiency

Serum A1AT

44
Q

a doctor does an ECG on someone with COPD, what condition is he looking for?

What features on an ECG will be +ve for this condition?
- 2 thigns

A

R. Sided heart failure

right BBB or right axis deviation

45
Q

pt has acute exacerbation of COPD.
You want to check their lactate and assess what type (1 or 2) resp failure they have.

Which Ix do you use?

A

ABG

46
Q

pt has acute exacerbation of COPD. you suspect an infective cause.

What Ix do you do to confirm infection and confirm the infective organism?

A

Sputum culture

47
Q

What are the two common options for nicotine replacement?

A

varenicline

bupropion

48
Q

pt has COPD,

what two vaccinations should they get?

A

one off pneumococcal & annual influenza

49
Q

pt has chronic productive cough, what is the 1st line therapy?

A

Oral Mucolytic therapy

50
Q

pt has COPD and is on treatment for this.

but now develops cor pulmonale, what is the additional management for this?
-2 things (name drug)

A

Furosemide

long term O2 therapy

51
Q

COPD pt cannot tolerate his inhaled medication.

What drug do you give?

class of this drug?

MOA of this drug?

A

Theophylline

bronchodilator

relaxes bronchial smooth muscle.

52
Q

pt with COPD, but he is refractory to bronchodilator therapy.

which drug can help this?

A

Roflumilast

53
Q

pt newly diagnosed with COPD

what is the 1st line medical MX for all patients?

A

1st: SABA or SAMA

54
Q

pt newly diagnosed with COPD.

what is the most effective intervention to treat him?

A

stop smoking

55
Q

pt newly diagnosed with COPD. he is asthma/steroid responsive.

his SABA and SAMA does not help.

What is the next Medical MX?

A

LABA + ICS

56
Q

pt newly diagnosed with COPD. he is asthma/steroid irresponsive.

his SABA and SAMA does not help.

What is the next Medical MX?

A

LABA + LAMA

57
Q

pt newly diagnosed with COPD . he is put on 1st line drug management.

What is the drug class? (2)

the drug is working, so what should his management be?

A

1st: SABA or SAMA

continue with SABA/SAMA

58
Q

pt has COPD, he is asthma responsive.

SABA/SAMA is ineffective.
LABA + ICS also ineffective.

What is the next cocktails of drugs for him?

A

LABA + LAMA + ICS

59
Q

define Acute Exacerbation of COPD

A

an acute worsening of respiratory symptoms.

60
Q

what could trigger an acute exacerbation of COPD?
- 3 things

what do these triggers do to inflammation?

A

infection, air pollutants, allergens

↑inflammatory cells

61
Q

what is the most common trigger for an acute exacerbation of COPD?

A

infection

62
Q

As COPD worsens the acute exacerbations get worse

true or false?

A

true

63
Q

Some exacerbations are very long and thus deteriorate lung function permanently

true or false?

A

true

64
Q

all infective exacerbations are bacterial.

true or false?

A

false

65
Q

why exactly does an inflammatory trigger worsen COPD symptoms

A

inflammatory trigger –> ↑macrophages + neutrophils –> ↑↑↑mucus, bronchoconstriction, ↑proteases –> symptoms worse

66
Q

most common infective cause for acute exacerbation of COPD in smokers?

A

Haemophilus influenzae

67
Q

most common viral cause for acute exacerbation of COPD in smokers?

A

Rhinovirus

68
Q

someone has acute exacerbation of COPD.

what is the hallmark symptom to suggest an infective trigger?

A

↑sputum + changes colour

69
Q

signs of acute exacerbation of COPD.

- 5 things

A 
Hypoxic 
Tachypnoea 
Acute confusion 
New-onset peripheral oedema 
New-onset cyanosis
70
Q

pt has acute exacerbation of COPD.

What is the initial assessment (1st line) comprised of?
- 4 things

A

Vitals
GCS – confusion
Examine chest
Check ability to cope at home

71
Q

how is acute exacerbation of COPD diagnosed?

A

Clinical diagnosis

72
Q

is a sputum culture routinely done for acute exacerbation of COPD?

A

no

73
Q

pt has acute exacerbation of COPD, there are sputum changes?

What is line Mx?
- 3 things

A

↑bronchodilator
Prednisolone 30mg 7-14 days
AB

74
Q

pt has acute exacerbation of COPD.

which steroid is given, dose, how long?

A

Prednisolone 30mg 7-14

75
Q

which AB are 1st line for acute exacerbation of COPD?

what is the mnemonic for this?

A

amoxicillin, clarithromycin, doxycycline

abc easy as adc

76
Q

pt has acute exacerbation of COPD.

what features would make you admit them to hospital?
- 6 things

A 
Severe breathlessness 
O2 sats <90% 
Acute confusion 
Can’t cope at home (or living alone) 
Already on LTOT 
Changes on CXR
77
Q

pt has acute exacerbation of COPD.

what feature is required for antibiotic prescription?

A

sputum changes

78
Q

pt comes to A&E with acute exacerbation of COPD.

he is assessed and told he can go home.

which Mx is used for all of these patients who go home?

A

1st Line: ↑short acting bronchodilator

79
Q

pt comes to A&E with acute exacerbation of COPD.

he is assessed and told he can go home. he is put on ↑short acting bronchodilator but says he struggles with daily activities.

what drug is now indicated?

A

Prednisolone

80
Q

pt has acute exacerbation of COPD and is told he can be managed at home.

at home he struggles with daily activities because of his symptoms.

what drug is now indicated?

A

Prednisolone

81
Q

pt has acute exacerbation of COPD, no sputum culture is done but he is on put AB.

when is a sputum culture done for acute exacerbation of COPD?

A

If AB have not worked – then send sputum culture

82
Q

should all exacerbations be followed up.?

and is so when?

A

yes

after 6 weeks

83
Q

emphysema etymology?

A

emphusan - puff up

84
Q

sama stand for what?

A

short acting muscarinic antagonists ipratropium

85
Q

sama example?

A

ipratropium

Respiratory (22 decks)

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