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First Year > COPD (Obstructive Airway Disease) > Flashcards

COPD (Obstructive Airway Disease) Flashcards

1
Q

What is COPD?

A

It is a progressive disorder characterized by airway obstruction with little or no reversibility

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2
Q

What is the type of inflammation involved in COPD?

A

Chronic neutrophilic inflammation of the airways, alveoli and pulmonary vasculature, with the principle cause of this being smoking.

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3
Q

What are the two underlying pathophysiological mechanisms to COPD?

A

Chronic bronchitis and Emphysema

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4
Q

Why does chronic bronchitis occur?

A

Due to inflammation within the airways

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5
Q

What is the resulting effect of chronic bronchitis on the airways?

A

Fibrosis of the bronchiole walls, airway oedema, bronchoconstriction and mucous hypersecretion

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6
Q

What symptoms occur as a result of chronic bronchitis?

A

A chronic cough and narrowing of the airways

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7
Q

What is the clinical definition of bronchitis?

A

A productive cough on most days for greater than 3 months of the year over two successive years

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8
Q

How does emphysema occur?

A

Inflammation of the smaller airways distal to the terminal and the alveoli results in the release of enzymes that breakdown the alveolar walls and capillaries

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9
Q

What is the resulting effect of emphysema on the airways?

A

Enlargement of the air spaces, reduced gas exchange and air trapping on expiration due to loss of elastic recoil

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10
Q

What type of deficiency can cause emphysema?

A

Alpha 1 anti-trypsin deficiency

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11
Q

What is the general presentation of COPD?

A

History of smoking, progressively worsening SOB / productive cough ( grey / white sputum) and reduced exercise tolerance and ability to carry out daily activities

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12
Q

What are some general signs of COPD?

A
  • Cyanosis
  • Tachypnoea
  • Use of accessory muscles of respiration
  • Barrel chest (due to hyperinflation)
  • Hyper resonance on auscultation
  • Wheeze and quiet breath sounds
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13
Q

What is the impact of emphysema clinically?

A

The body acts to overcome the reduced gas exchange through hyperventilation, which allows a near normal Pa02 and PaC02 to be maintained

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14
Q

What are the typical presenting features of emphysema?

A
  • Pink complexion (as not really cyanosed)
  • Hyperventilation with use of accessory muscles and leaning forward to help with air movements
  • Mild cough
  • Thin and cahexic
  • Reduced breath sounds on auscultation
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15
Q

What is meant by the term ‘pink puffers’ when referring to COPD?

A

Patients who present with predominantly Emphysema

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16
Q

What is the impact of chronic bronchitis clinically?

A

Due to the airway narrowing, there is a reduction in the ventilation of the alveoli. The body acts to overcome this by increasing cardiac output. This results in a V/Q mismatch, hypoxia (low Pa02) and hypercapnia (high PaCO2). The hypoxia results in pulmonary hypertension and eventually cor pulmonale.

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17
Q

What are the typical presenting features of chronic bronchitis?

A
  • Blue complexion (as cyanosed)
  • Not breathless
  • Prominent cough with lots of sputum
  • Peripheral swelling due to cor pulmonale
  • Wheeze on auscultations
18
Q

What is meant by the term ‘blue bloaters’ when referring to COPD?

A

Patients who present with predominantly Chronic Bronchitis

19
Q

What investigations can be used to confirm a diagnosis of COPD?

A

Spirometry, bronchial challenge, DCLO, CXR & ABG

20
Q

What spirometry results would be indicative of COPD?

A

Decreased FVC & FEV1 and FER <75%.

21
Q

What bronchial challenge results would be indicative of COPD?

A

<15%

22
Q

What DCLO results would be indicative of COPD?

A

Reduced in emphysema

23
Q

What CXR results would be indicative of COPD?

A

Hyperinflation of chest, bullae

24
Q

What ABG results would be indicative of COPD?

A

Hypoxia +/- hypercapnia

25
Q

What FEV1 result would indicate mild COPD?

A

> 80%

26
Q

What FEV1 result would indicate moderate COPD?

A

50 – 79%

27
Q

What FEV1 result would indicate severe COPD?

A

30 – 49%

28
Q

What FEV1 result would indicate very severe COPD?

A

<30%

29
Q

What are the main complications of COPD?

A

Acute exacerbations, respiratory failure, cor pulmonale or pneumothorax.

30
Q

What is the general non-pharmacological management of COPD?

A
  • Smoking cessation
  • Encourage exercise
  • Flu jag to prevent infections
  • Pulmonary rehab
  • Dietary advice: either for low or high weight
31
Q

What is the main complication of inhaled steroids?

A

Increased risk of pneumonia

32
Q

What is step one of the general formula for the management of COPD?

A

SABA e.g salbutamol or SAMA e.g ipratropium

33
Q

What is step two of the general formula for the management of COPD?

A
  • Depends on FEV1
  • If FEV1 >50% = LABA e.g salmeterol or LAMA e.g tiotropium
  • If FEV1 <50% = LABA + ICS (e.g folmeterol + beclomethasone) or LAMA
34
Q

What is step three of the general formula for the management of COPD?

A

Combination of LABA + ICS + LAMA

35
Q

What medications are used to treat mild COPD?

A

Ipratropium PRN then Salbutamol PRN.

36
Q

What medications are used to treat moderate COPD?

A

Ipratropium PRN then Tiotropium or Salmeterol + inhaled steroids or consider oral theophylline

37
Q

What medications are used to treat severe COPD?

A

Triotropium, salmeterol + inhaled steroid then consider oral steroids

38
Q

What is used to treat pulmonary hypertension

A

Long term oxygen therapy

39
Q

When do acute exacerbations of COPD tend to occur?

A

Most commonly seen in winter and may or may not be associated with infections

40
Q

What is the presentation of an acute COPD exacerbation?

A

Increasing SOB / wheeze / cough and decreased exercise tolerance.

41
Q

What investigations would be done for an acute COPD exacerbation?

A
  • Bloods: FBC, CRP, ABG
  • Peak flow
  • CXR / ECG
  • Culture: sputum / blood
42
Q

What is the general management plan for an acute COPD exacerbation?

A
  • Controlled 02 (24 – 28%), with target of 88 – 92%
  • Nebulized salbutamol + ipratropium
  • Steroids: IV hydrocortisone (200) or oral prednisolone (30-40)
  • Amoxicillin if infection suspected

First Year (71 decks)

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