CPT2: COPD Flashcards
What is COPD?
COPD is characterised by chronic airway obstruction that interferes with normal breathing and is not fully reversible. It is an umbrella term for progressive lung diseases e.g. chronic bronchitis, emphysema and refractory
What is the pathopyhsiology of COPD and the 2 processes involved?
COPD is caused by the body response to inhaled stimuli, causing an inflammatory reaction. The inflammation reaction causes long term, irreversible changes in the airway and pulmonary vessels. There are 2 processes involved: Chronic bronchitis and emphysema
What role does chronic bronchitis in the pathophysiology?
What is chronic bronchitis defined as?
Chronic bronchitis is defined as a cough productive of sputum, occuring most days in 3 consecutive months over 2 consecutive years
Continual irritans ause the bronchi/bronchioles to become inflammed and swollen. The smooth muscle becomes thicker and the airways narrower. There is hypertrophy of goblet cells leading to increased mucus production. The cillia cannot cope with the excess production of mucus and it begins to block the airways too. Together there is narrowing of the airways which is not fully reversible
What is emphysemea defined as?
What role does it play in the pathophysiology?
Defined as an enlargement of the distal airspace
Inhalation of toxic particles over time causes alveolar inflammation. This causes the walls to become thinner, eventually dissolving. There is therefore enlargement of gas exchange spaces and so gas exchange becomes less effective.
Fibrosis of the tissue can also occur leading to gas trapping and airflow limitation
In COPD what are the majority of symptoms caused by?
What can this lead too?
The air restiacne in COPD patients can lead to hypoxia or a lack of O2 in the blood, causing the majority of symptoms
Long term hypoxia can lead to thickening of vascular smooth muscle leading to pulmonary hypertension and poor prognosis
What are the symptoms of COPD?
-
Dyspnoea/ breathlessness
- To begin with during periods of exertion, however as it progresses it can be at minimial exertion or at rest
-
Cough
- Intermittent
- Particularly early morning
- Productive
-
Sputum prodcution
- Increased production
- Change in colour (purulent) or volume can be a sign of exacerbation or infection
- Fatigue
- Anorexia/ weightloss
- Chest tightness
- Wheezing
- Repeated respiratory infections
Epidemiology
Chances increases with age
- UK prevalence
- 3 million people affected (1.2million diagnosed)
- More common in males (1.7% vs 1.4%)
- Diagnosis – usually in mid 50’s
- Associated with low socioeconomic status
- Rates higher in deprived communities
- Associated with co-morbidities
- cardiovascular disease, lung cancer, depression, anxiety, osteoporosis, muscle weakness
- COPD is the second largest cause of emergency admissions and so one of the most expensive inpatient conditions treated by the NHS.
What is the aetiology of COPD?
Usually caused by significant exposure to noxious particles or gas
- Smoking
- Air pollution
- motor emissions, burning coal/wood
- Occupational exposures
- Chemicals
What does a diagnosis of COPD look like in terms of what background/ charaterisitics they should have?
COPD should be considered in patients who are:
- Over 35
- Smokers or ex-smokers
- Determine accurate smoking history.
- Pack years = no of cigarettes daily/20 x no. of years smoked
- Symptomatic with
- Exertional breathlessness
- Chronic cough
- Regular sputum production
- Frequent “winter bronchitis” or wheeze
What does a diagnosis of COPD involve?
- Determine accurate medical history
- Exposure to noxious fumes
- Confirm co-morbidities
- Increase symptoms of breathlessness
- Allergies
- Accurate employment history
- Determine history of COPD or other chronic respiratory diseases
- Airway flow obstruction and disganosis needs to be confimed by spirometry
What does spiromerty measure?
The volume and rate at which air is forced out of the lungs after maximum inspiration
What can spirometry assess?
- •Obstructed by narrowed or inflamed airways
- •Diagnose lung conditions
- •Grade severity of condition
- •Can aid assessment of inhaled therapies
- •reversibility testing (<200ml)
How is reversibility determined by spirometry for COPD?
As COPD has limited reversibility, after administration of a bronchodilator (Salbutamol) there should be a change of less than 200ml in the FVC
What is the FVC value?
•Total amount of air blown out after taking a deep breath in & blown out as hard and fast until your lungs are completely empty
What is the FEV1 value?
•The amount of air blown out in one second. In healthy lungs and airways you can blow out the majority of air from your lungs in one second.
What is the GOLD classification of COPD?
What is the mMRC classifcation grading for COPD breathlessness?
What does a full COPD assessment involve?
- Degree of obstruction – spirometry results
- Current nature and magnitude of patient’s symptoms
- mMRC Score, CAT Assessment.
- History of moderate and severe exacerbations
- Presence of co-morbidities
What is the pharmacological treatment according to GOLD for COPD?
LAMA - superior efficacy at reducing risk of exacerbations
ICS - also reduced risk of exacerbations
Stage D:
LAMA reccomended unless highly symptomatic then LABA recommended. If high eosinophils >300 then LABA and ICS recommended
What is pharmacological treatment according to NICE NG 115 Guidlines?
It is important to regularly reassess patients to ensure goals are being met.
What does this process involve?
Always assess inhaler compliance and technique at every appointment
Which symptoms indicate mild, moderate and severe exacerbations?
When should a patient be treated at home and when should they be treated in hospital?
What AB should be prescribed for exacerbations if bacterial infection present?
1st line and 2nd lines
