COPD part 1 (009) Flashcards
what are the risk factors of COPD ?
smoking factory fumes pollution alpha 1 antitrypsin deficiency impaired lung development severe infections in childhood ( measles) long standing bronchial asthma
when to suspect alpha 1 anti trypsin deficiency ?
young patient who is a non smoker and no exposure to any of the COPD risk factors
is inspiration an active or passive process ?
active whilst expiration is passive
what is the pathophysiology involved with COPD?
air trapping (poor ventilation ) ventilation/perfusion mismatch chronic hypoxia (cor pulmonale)
what is the main cause of low oxygen saturation in emphysema patients ?
v/q mismatch
what is the main cause of low oxygen saturation in Chronic bronchitis?
poor ventilation / air trapping
which disease is commonly associated with pink puffers ?
emphysema
which disease is commonly associated with blue bloaters?
chronic bronchitis
consequence of v/q mismatch vs. air trapping ?
v/q mismatch – hypoxia
air trapping – hypercapnia
what are the spirometry requirements for making a diagnosis of COPD ?
- decreased FEV and FVC
- expiration take a longer time
- increased residual volume (RV) of air after expiration
- increased total lung volume (TLV)
what is the cut off value for the FVC/FEV1 ratio to diagnose COPD ?
less than 70% post bronchodilator
what other pulmonary function tests can be used to diagnose COPD ?
1-platysmography
2- diffusion capacity of CO
3- exercise testing
what are the types of exercise testing used for pulmonary function test ?
6 minute walk test
cardiopulmonary exercise testing
what kind radiological imaging methods can be used ?
chest x-ray
CT scan
what are the radiological findings of COPD on a chest X-Ray?
ribbon shaped hearts
flat diaphragm
hyper translucency
hyperinflation
what laboratory tests would you ask for ?
ABG CBC Sputum culture and sensitivity alpha 1 antitrypsin blood levels blood eosinophil count
what are the complications of COPD ?
respiratory failure heart failure pneumothorax bronchieactsis depression recurrent exacerbations
what is cor pulmonale ?
Cor pulmonale is a condition that causes the right side of the heart to fail. Long-term high blood pressure in the arteries of the lung and right ventricle
what are the three main management options ?
general measures
drugs
surgical
what are examples of general measures ?
cessation of smoking vaccination against influenza and pneumonia exercise nutrition Rehabilitation
what are the surgical options ?
lung volume reduction
lung transplantation
what are the types of bronchodilators ?
b2 agonists
anticholinergics
methylxanthines
what are examples of each of :
b2 agonists
anticholinergics
methyxanthines
1. b2 agonists - SABA salbutamol ( short acting LABA formeterol ( long acting) indaceterol ( ultra long lasting)
- anticholinergics- short acting ipratopium bromide
long acting - tiotropium - short acting aminophylline
ultra-long acting - theophylline
mechanism of b2 agonist ?
activation of g proteins - cAMP- inhibition of calcium release leads to bronchodilation
what are the side effects of b2 agonists ?
palpitations
hypokalemia
tremors
anxiety
what is the method of administration with anticholinergics ?
given by inhalation ONLY
which is more effective LAMA or LABA in the reduction of exacerbation rates inn COPD ?
LAMA
what is the mechanism of anticholinergics ?
block acetylcholine
what are the side effects of anticholinergics ?
dry mouth , bitter metallic taste
poor systemic absorption
what is the method of administration of methylxanthine ?
oral or intravenous and not by inhalation
aminophylline - rescue
theophylline - maintenance
small bronchodilator effect modest symptomatic improvement
what is the mechanism of action with methylxanthine ?
inhibition of phosphodiesterase
what are the side effects of methylxanthine ?
cardiac
cns stimulation
GIT
what anti inflammatory drugs can be used ?
inhaled corticosteroids
systemic corticosteroids
phophodiesterase-4-inhibitors
macrolide
how can the treatment benefit of `ICS be predicted ?
by blood eosinophil count (>300 cell shows greates benefit whilst <100 is less likley
what are the side effects of ICS ?
oral candidiasis, hoarsness of voice
risk of pneumonia
what type of anti-inflammatory drug is more likely to be used with acute exacerbations ?
systemic corticosteroids (e.g prednisolone) not recommended for longer durations
what are the side effects of predinsolone (systemic corticosteroids)?
immunosuppression
muscle weakness gastritis/peptic ulcer
osteoporosis
what are the indications to giving phosphodiesterase inhibitors ?
in COPD patiients who hhave a FEV1 of less than 50% and frequent exacerrbations despite ICS LABA LAMA
an example of a phosphodiesterase 4 inhibitor ?
roflumilast
what is the contraindication of using phosphodiesterase inhibitors?
methylxanthine ( which is also contraindicated in asthma patients )
what antibiotics can be used for COPD patients ?
macrolide (azithromycin) 250mg once a day for a year
what are the expected findings in an ABG ?
hypoxemia
hypercapnia
type 2 resp failure
what is expected to bee seen on a CBC of a patient with COPD ?
secondary polycythemia
in order to increase O2 capacity
what is the inherritedd form of emphysema called ?
alpha 1 antitrypsin blood level
what are the essential criteria needed to establish a diagnosis of COPD ?
persistent dyspnea/cough
history of smoke exposure
low FEV1/FVC
large volume on x-ray
what is the significance of performing blood eosinophil count in a patient with COPD ?
if they have a count higher than 300 they are more likely to respond and benefit from ICS
and have a higher risk of exacerbation
should methylxanthine be used in an acute exacerbation ooff COPD?
not recommended
patient is arrythmic and in CCOPD exacerbation ?
avoid beta. 2 agonists as they already cause arrythmias
