COPD II Flashcards
What does COPD include?
- emphysema – damage to the air sacs in the lungs
* chronic bronchitis – long-term inflammation of theairways
What are the main symptoms of COPD?
- -increasingbreathlessness, particularly when you’re active
- a persistent chestycoughwith phlegm– some people may dismiss this as just a “smoker’s cough”
- frequentchest infections
- persistent wheezing
What are the causes of COPD?
happens when the lungs become inflamed, damaged and narrowed
What are the treatments of COPD?
- slow down progression
1. stopping smoking– if you have COPD and you smoke, this is the most important thing you can do
2. inhalersand medicines – to help make breathing easier
3. pulmonary rehabilitation–a specialised programme of exercise and education
4. surgery or alung transplant– although this is only an option for a very small number of people
How can you prevent COPD?
avoid smoking
What are less common symptoms of COPD?
- weight loss
- tiredness
- swollen anklesfrom a build-up of fluid(oedema)
- chest painandcoughing up blood– although these are usually signs of another condition, such as achest infectionor possiblylung cancer
What are the causes of COPD?
- Smoking
- Fumes and dust. at work
- Air pollution
- Genetics
What substances have been linked to COPD?
- cadmium dust and fumes
- grain and flour dust
- silica dust
- welding fumes
- isocyanates
- coal dust
How do genetics influence COPD?
more likely to develop COPD if you smoke and have a close relative with the condition, which suggests
some people’s genes might make them more vulnerable to the condition
What deficiency can cause COPD?
1 in 100 people with COPD hasa genetic tendency to develop the condition, called alpha-1-antitrypsin deficiency
What is alpha-1-antitrypsin?
substance that protects your lungs
What can a GP do to help diagnose COPD?
- ask you about your symptoms
- examine your chest and listen to your breathing using a stethoscope
- ask whether you smoke or used to smoke
- calculate yourbody mass index (BMI)using your weight and height
- ask if you have a family history of lung problems
What other tests can be done?
- Spirometry
- Chest X ray
- Blood tests
What is spirometry?
- breathe into a machine called a spirometer after inhaling a medicine called abronchodilator, which helps widen your airways
- 2 measurements: the volume of air you can breathe out in a second, and the total amount of air you breathe out
Why are blood tests done?
- low iron level(anaemia)
- ahigh concentration of red blood cells in your blood(polycythaemia).
- alpha-1-antitrypsin deficiency
What further tests may be done?
•anelectrocardiogram (ECG)– a test that measures the electrical activity of the heart
•anechocardiogram–anultrasound scanof the heart
•apeak flow test– a breathing test that measureshow fast you can blow air out of your lungs, which can help rule out asthma
-a blood oxygen test – a peg-like device is attached to your finger to measure the level of oxygen in your blood
•aCT scan–a detailed scan that can help identify any problems in your lungs
•a phlegm sample – a sample of your phlegm (sputum) may be tested to check for signs of achest infection
What are the two main types of inhalers used in treatment?
- Long-acting bronchodilator inhalers
2. Short acting bronchodilators
What are long acting?
- beta-2 agonist inhalers –such as salmeterol, formoterol and indacaterol
- antimuscarinic inhalers–such as tiotropium, glycopyronium and aclidinium
What are short acting?
- beta-2 agonist inhalers –such assalbutamoland terbutaline
- antimuscarinic inhalers–such as ipratropium
What are steroid inhalters?
- still becoming breathless when using a long-acting inhaler, or you have frequent flare-ups (exacerbations)
- containcorticosteroid medicines, which can help to reduce the inflammation in your airways
What are theophylline tablets?
-type of bronchodialtor taken twice a day
-Side effects:
•feeling and being sick
•headaches
•difficulty sleeping(insomnia)
•noticeable pounding, fluttering or irregular heartbeats(palpitations)
What are mucolytics?
- a persistent chesty cough with lots of thick phlegm. (makes phlegm thicker)
- carbocisteine 3-4 times a day
When are steroid tablets used?
-Bad flare up short course
-LT side effects:
•weight gain
•mood swings
•weakened bones(osteoporosis)
When would you be prescribed antibiotics?
-sign of chest infection:
•becoming more breathless
•coughing more
•noticing a change in the colour (such as becoming brown, green or yellow) and/or consistency of your phlegm (such as becoming thicker)
What is pulmonary rehabilitation?
-2 or more group sessions a week for at least 6 weeks.
A typical programme includes:
•physical exercise training tailored to your needs and ability– such aswalking, cycling and strength exercises
•education aboutyour conditionforyou andyour family
•dietary advice
•psychological andemotional support
What is nebulised medicine?
- severe cases of COPD if inhalers have not worked
- machine is used to turn liquid medicine into a fine mist that youbreathe inthrough a mouthpiece or a face mask - enables a large dose of medicine to be taken in one go
What is rofumilast?
- symptoms have suddenly become worse at least 2 times over the past 12 months and already using inhalers
- Side effects of roflumilast include
•feeling and being sick
•diarrhoea
•reduced appetite
•weight loss
•headache
What is LT oxygen therapy?
oxygen at home through nasal tubes or a mask at least 16hr a day
What is ambulatory oxygen therapy?
- oxygen you use when you walk or are active in other ways
- oxygen levels are normal while you’re resting but fall when you exercise
What is non-invasive ventilation?
- taken to hospital because of a bad flare-up, you may have a treatment called non-invasive ventilation (NIV)
- portable machine connected to a mask that covers your nose or face is used to support your lungs and make breathing easier
What is a bullectomy?
an operation to remove a pocket of air from one of the lungs, allowing the lungs to work better and make breathing more comfortable
What is lung volume reduction surgery?
an operation to remove a badly damaged section of lung toallow the healthier parts to work better and make breathing more comfortable
What is lung transplant?
an operation to remove and replace a damaged lung with a healthy lung from a donor
What is hypoxemia?
PaO2 < 60mmHg (8kPa)
What is hypercapnia?
paCO2 > 50mmHg (6.7kPa)
What is acidosis?
pH<7.35
What is alkalosis?
pH.7.45
What is hypoxemic respiratory failure known as?
- Type 1 ARF
- Lung failure
- Oxygenation failure
- respiratory insufficiency
What is the definition of hypoxemic respiratory failure?
failure of lungs and heart to provide adequate O2 to meet metabolic needs
What is the criteria for hypoxemic respiratory failure?
PaO2 < 60 mmHg on FiO2 >50 or PaO2 < 40mmHg on any FiO2 SaO2<90
What are the basic causes of hypoxemic respiratory failure?
- R-L shunt
- V/Q mismatch
- Alveolar hypoventilation
- Diffusion defect
- Inadequate FiO2
What is hypercapnic respiratory failure known as?
- Type II ARF
- Pump failure
- Ventilatory failure
What is the definition of hypercapnic respiratory failure?
The failure of the lungs to eliminate adequate CO2
What is the criteria of hypercapnic respiratory failure?
Acute increase in PaCP2>50mmHg or Acutely above normal baseline in COPD with concurrent decrease in pH <7.30
What are the basic causes of hypercapnic respiratory failure?
- Pump failure (drive, muscles, WOB)
- Increase CO2 production
- R-L shunt
- Increase Deadspace
What does high PCO2 from acidemia cause?
respiratory acidosis
What does low HCO3 from acidemia cause?
metabolic acidosis
What does a low PCO2 from alklemia cause?
respiratory alkalosis
What does a high HCO3 from alklemia cause?
metabolic alkalosis
What is compensation of respiratory acidosis?
Metabolic alkalosis
What is compensation of metabolic acidosis?
respiraotry alkalosis
What is compensation of metabolic alkalosis?
repsiratory acidosis
What is compensation of respiratory alkalosis?
metabolic acidosis
What can cause Type 1 respiratory failure?
- Pneumonia
- Pulmonary embolism
- Pulmonary fibrosis
- Aspiration
- Asthma
- Pneumothorax
- Pulmonary contusion (blunt chest trauma)
- Pulmonary oedema £
- ARDS £
- Lung collapse £ e.g. retained secretions
What can cause Type 2 respiratory failure?
- Upper airway obstruction (oedema, infection, foreign body)
- Late severe acute asthma
- COPD
- Flail chest injury
- Reduced respiratory drive e.g. drug overdose, head injury £
- Peripheral neuromuscular disease e.g. MG and GB £
- Exhaustion (includes all type 1 causes) £
Why is there swelling in the ankles and feet?
- Alveolar hypoxia
- Hypoxic vasoconstriction
- Pulmonary vascular resistance
- Pulmonary hypertension
- Right ventricular afterload
- Right ventricular failure
- Peripheral oedema
- Swelling of ankles and feet
What are the 4 steps interpreting a blood gas report?
- Look at pH and determine if acidic, alcolotic or normal
- What is the primary disturbance: metabolic or respiratory
- For metabolic acidosis: is there a high anion gap?
- Is there any compensation
What happens a patient CO2 increases?
patient cannot increase their respiratory drive then there will be an increase in carbonic acid formation and a decrease in pH and this leads to RESPIRATORY ACIDOSIS
What happens if a patient hyperventilates?
carbon dioxide will fall and so there will be a reduction in carbonic acid this will lead to a rise in the pH leading to RESPIRATORY ALKALOSIS
What happens in the kidneys with HCO3-?
- bicarbonate homeostasis they 1. regulate the reabsorption of bicarbonate ions in the proximal tubule
2. form bicarbonate ions through the excretion of ammonia and monophosphate ions
3. increase hydrogen ion excretion and therefore increased blood pH
What is bicarbonate ion normally?
22-28mmol/L
What happens in metabolic acidosis?
- increase in acid in the blood 2. Or there is insufficient generation of bicarbonate ions in the kidneys
What happens in metabolic alkalosis?
- Loss of hydrogen ions
2. Abnormal increase in bicarbonate ions
In metabolic acidosis what is the acidemia caused by?
increase in hydrogen ions or a loss in bicarbonate ions determine using anion gap
What is anion gap?
main cation in the blood which is Na+ and subtracts the main anions which are bicarbonate and chloride
What is anion gap usually?
- 8-16mmol/L
- Sometimes potassium is included in the equation as another cation (plus) and so the normal range is increased from 12-20 mmol/L
What is a high anion gap caused by?
- Increase in unmeasured anions caused by hydrogen ions reacting with the bicarbonate ions
- lactic acidosis, ketoacidosis, toxins and renal failure
What happens in a normal anion gap?
metabolic acidosis the lost bicarbonate ions are replaced with chloride ions - the most common causes of this are diarrhoea and renal tubular acidosis
When does respiratory compensation increase?
begins in the first hour
What is hypoventilation in metabolic alkalosis?
less pronounced and rarely retains carbon dioxide beyond 7.5 kilopascal
What does the kidney do if the patient has respiratory acidosis?
kidney attempt to retain more bicarbonate ions and to excrete more hydrogen ions in order to raise the pH: this takes several days to achieve so tend to be evident in chronic respiratory conditions
