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Hospital Based Medicine And Surgery > L11: COPD And Its Management > Flashcards

L11: COPD And Its Management Flashcards

1
Q

What is COPD

A

Chronic (irreversible) obstructive (FEV1/FVC ratio less than 0.7) pulmonary disease

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2
Q

What are the causes of COPD

A

Smoking

Anything that causes a continues inflammation e.g untreated asthma

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3
Q

What happens to the lungs when we breath in and out

A

Breathing in: contract diaphragm so its flat and pull our intercostal muscles up and out to pull air in

Breathing out: elastic recoil allows lungs and lung tisse to recoil into a relaxed stated and then pushes air out

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4
Q

In COPD what happens to our breathing and why

A

Ongoing inflammation causes a degradation in protein scaffold so airway cant be remained open during expiration and they collpase

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5
Q

What happens to the flow volume loop in COPD

A

Durin expiration: patients pushes out air in first 2 seconds by muscular force
After 2 seconds the airway resistance and inflammation works against it so the patient is unable to expire a significant amount of volume with time as they expire

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6
Q

What is gas trapping in COPD

A

The inability of the lung to fully exhale which leads to abnormal expansion or hyperinflation of the lungs. Having trapped air combined with extra effort to breathe results in a person feeling short of breath

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7
Q

What is the treatment of COPD

A

Bronchodilator- open airway

Corticosteroid- reduce inflammation

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8
Q

What are the COPD phenotypes

A

Chronic bronchitis

Emphysema

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9
Q

What is chronic bronchitis

A

Chronic sputum production for greater than 3 months per year for 2 consecutive years

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10
Q

What is emphysema

A

A histological diagnsosis of breakdown of the aleveolar tissue

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11
Q

How do we diagnose COPD

A

By spirometry

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12
Q

What should a spirometry for COPD show

A

FEV1/FVC less than 0.7

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13
Q

After looking at the FEV1/FVC ratio what can we look at to determine the severity of COPD

A

FEV1

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14
Q

What is the pattern in FEV1 with the severity of COPD

A

The less the FEV1 the more severe COPD is

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15
Q

What is the pathophysiology of COPD

A
  1. Cigarette smoke that is inhaled triggers the activation of macrophages
  2. Macrophages produce il8, ltb4 whcih recruit neutrophils
  3. Neutrophils produce proteases
  4. Proteases kill local bacterial infection
  5. Proteases cause alveolar wall destruction (emphysema) and mucus hypersecretion (chornic bronchitis)
  6. This causes airflow obstruction
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16
Q

What does alpha 1 antitrypsin deficiency cause

A
  1. Alpha 1 anti trypsin deficiency is a deficiency of the enzyme alpha 1 trypsin which is a neutrophil protease inhibitor
  2. Therefore proteases can be inhibited
  3. This leads to ongoing destruction - this time not due to smoking
17
Q

What are the causes of COPD

A

Smoking
Occupational expoure: dust, cotton textile
Indoor air pollution
Genetic: alpha 1 anti trypsin deficiency

18
Q

What are blue bloaters

A

Chronic bronchitis

19
Q

What are pink puffers

A

Emphysema

20
Q

What are blue bloater features

A 
Blue 
Overweight
Elevated hb
Peripheral oedema
Wheezing
21
Q

What are pink puffer features

A

Quite chest
Older and thiner
Hyperinflatetion with flattened diaphragm on xray

22
Q

What are the symptoms and signs of COPD

A 
SOB
Chronic cough
Wheeze
Right heart failure
Barrel chest
Nocturnal and early morning symptoms
23
Q

Apart from a spirometry what are the other investigations

A 
FBC: hb will increase due to hypoxia
Cxr: flattened diaphragm and hyperinflation
ABG
CT
ECG- right heart strain
Alpha 1 anti trypsin deficiency
24
Q

What is the stepwise management for COPD

A
  1. Stop smoking
  2. Conservative measures: reduce occupational and environemtnal exposure, exercise, vaccine, mucolytic drugs
  3. Bronchodilator or antimuscarinic: shor acting bronchodilator for occasional use and long acting bronchodilator used regularly
  4. Inhaled corticosteroids
  5. Consider: oral theophylline, home nebuliser, long term domicliary oxygen therapy, pulmonary rehabilitation, surgical intervention
25
Q

What are complications of COPD

A

Chronic hyoxaemia:
Cor pulmonale and right ventricular failure- due to backflow of blood to the right ventricular system
Pneumothorax: due to hyperinfiltations and lung pops
Type 2 respiratory failure
Arrhythmia
Infection

26
Q

What is the first line treatment of COPD

A

SABA or SAMA

27
Q

If the patient has no asthmatic features suggesting steroid resposiveness what is the next line management of COPD

A

LAMA and LABA (if on SAMA as first line switch to SABA)

28
Q

What is the next line management in COPD for someone that has asthmatic features and steroid responsiveness

A

LABA and inhaled ICS

29
Q

If the patient has exacerabations or remains breathless what is the next line treatment

A

LABA+ICS+LAMA (SABA as first line)

Hospital Based Medicine And Surgery (30 decks)

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