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Lecture 9 - COPD And Bronchiectasis Flashcards

1
Q

What is COPD?

A

A disease characterised by persistence respiratory symptoms and airflow limitation

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2
Q

What causes COPD?

A

Significant exposure to noxious particles and gases affecting the airways and alveoli

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3
Q

What happens to the airways in COPD?

A

Airway inflammation
Airway fibrosis
Increased airway resistance

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4
Q

What happens to the parenchymal tissue in the lungs with COPD?

A

Parenchymal destruction

Loss of alveolar attachments
Decrease of elastic recoil

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5
Q

What are some classic respiratory symptoms associated with COPD?

A

Breathlessness
Cough
Sputum

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6
Q

What is the main risk factor/causative toxin causing COPD?

A

Smoking

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7
Q

What airways are first affected in COPD?

A

Small airways

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8
Q

What are the changes that occur in chronic bronchitis?

A

Airways become inflammed narrowing the airway
Has increased mucus production

This narrowing of the airways causes breathlessness

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9
Q

What is Emphyesma?

A

A disease of the lung parenchyma where the alveoli are broken down

This leads to less gas exchange occurring
Lose the elastic recoil of the lungs causing overinflation

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10
Q

What are some causes of COPD?

A

Smoking
Biomass exposure
Alpha-1-antitrypsin (genetic)
Air pollution
Illicit drug use

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11
Q

What illicit drugs cause COPD?

A

Heroin
Cannabis

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12
Q

Why may certain people develop COPD without smoking?

A

As children the lung function may not have fully developed so as normal lung function decline occurs it can falll to COPD levels

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13
Q

What is the pathway to diagnosing COPD?

A

NEED SYMPTOMS
Then determine if they have risk factors for their symptoms
Then do spirometry

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14
Q

What are the symptoms of COPD?

A

Breathlessness progressively
Cough
Sputum

History of risk factors:
Host factors
Smoke
Occupational dusts

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15
Q

What is Dyspnoea?

A

Breathlessness

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16
Q

What are the signs of COPD?

A

Purse lip breathing
Hyperinflation or barrel shaped chest
Prolonged expiratory phase

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17
Q

When the doctor examines a patient what are some signs of COPD?

A

Wheeze on auscultation

Cyanosis (rare)
Cor pulmonale (right sided heart failure with a respiratory cause)

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18
Q

How does Cor pulmonale get caused with COPD?

A

COPD obstructs small bronchioles
Reduces ventilation of alveoli at the end of these bronchioles
Reduced pO2 in alveoli leads to hypoxaemia in blood
Pulmonary vasoconstriction occurs to redirect blood to better ventilated alveoli
Chronic pulmonary vasoconstriction leads to pulmonary hypertension
Cause right sided heart hypertrophy
Then right sided heart failure due to respiratory cause = Cor pulmonale

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19
Q

What is spirometry used to measure?

A

FEV1
FVC

From that can determine the FEV1:FVC ratio

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20
Q

What is FEV1?

A

Forced Expiratory Volume 1s

How much air can be moved out in one second

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21
Q

How is the FEV1:FVC ratio affected in patients with COPD (Chronic Obstructive Pulmonary Disease)?

What value indicates COPD?

A

Reduced since less air can be exhaled in a certain time due to the airway obstruction

FEV1:FVC < 0.7 or 70%

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22
Q

What other investigations can be done if suspect COPD expect for spirometry?

A

CXR (may see hyperinflation)
High Resolution CT (HRCT) - may see emphysema or Brochiectasis
Pulmonary function tests
ABG

Alpha-1-antitrypsin bloodo test for younger patients

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23
Q

What are exacerbations of COPD?

A

Acute worsening of respiratory symptoms that need additional therapy

24
Q

What are some common infectious organisms that worsen COPD?

A

Bacteria:
Haemophilus influenzae
Streptococcus pneumoniae
Pseudomonas aeruginosa

Viruses:
Rhinoviruses
Influenza

25
Q

What some therapies for improving symptoms of COPD?

A

Pulmonary rehabilitation
Bronchodilators (Beta2 agonists and anti-muscarinics)
Lung transplant
Mucolytics

26
Q

What are some therapies that help reduce risk of COPD?

A

Smoking cessation
Oxygen therapy (Long term oxygen or ambulatory oxygen)
Anti inflammatories (inhaled corticosteroids)

27
Q

How is smoking cessation helpful for COPD?

A

Reduces mortality
Improves symptoms
Slow down loss of lung function
Reduces exacerbations
Drug work better

28
Q

What is pulmonary rehabilitation?

A

An exercise program lasting 6-8weeks

Its VERY EFFECTIVE

29
Q

What are the 3 drugs that can be given in COPD?

A

2 bronchodilators
Inhaled corticosteroids

30
Q

What are the 2 bronchodilators that can be given in COPD?

A

B2 agonists (LABA) Long lasting Beta agonists
Muscarinic antagonists (LAMA)

31
Q

Why are inhaled corticosteroids so effective?

A

Directly delivered to organ (minimal systemic absorption)

Prevents inflammation so helps reduce exacerbation frequency

32
Q

What COPD patients are normally given Inhaled corticosteroids?

A

People with high eosinophils count since it works against T2

33
Q

When is Long Term Oxygen Therapy given to a COPD patient?

A

When Hypoxaemia is occurring at rest to try and protect key organs like heart and kidneys

If pO2 < 7.3kPa

34
Q

When is Ambulatory oxygen given to a COPD patient?

A

If patients desaturate when walking and they then are able to walk further with the oxygen

35
Q

Are the changes in the lungs in COPD reversible?

A

Irreversible

36
Q

What is Bronchiectasis?

A

The permanent irreversible dilatation of airways

37
Q

What is the pathophysiology of Bronchiectasis?

A

Destruction of elastic and smooth muscle in the bronchi leads to dilatation of airways
Leads to mucus build up making prone to recurrent or chronic bacterial infections

38
Q

What are the symptoms of Bronchiectasis?

A

Cough with sputum (significant amount, how much can you fill?)

Recurrent infections/exacerbations

Haemoptysis

Weight loss

39
Q

What are some causes of Bronchiectasis?

A

TB, Pneumonia, pertussis (whooping cough)

Impaired muco-ciliary clearance : cystic fibrosis, Primary ciliary dyskinesia

COPD

Autoimmune = IBD, Rheumatoid arthritis

Ataxia-Telangiectasia and Marfan’s

40
Q

What do you do to diagnose Bronchiectasis?

What imaging?

A

Productive
Crackles on auscultation

CT SCAN CAN DIAGNOSE

41
Q

How can you diagnose Bronchiectasis using imaging?

What is the sign?

What actually is the sign?

A

CT scan

Signet ring sign

Where the bronchus/airway has a larger diameter than the blood vessel (pulmonary artery)

42
Q

How is Bronchiectasis treated?

A

Clear airways of mucus (decreases infection risk):
Mucolytics
Hypertonic saline to make you cough

Low dose macrolides

Inhaled corticosteroids and bronchodilators

43
Q

How are low dose macrolides helpful in treating Bronchiectasis?

A

Act as anti inflammatorys and antibiotics

44
Q

Why do inhaled corticosteroids and bronchodilators have minimal effect in Bronchiectasis?

A

Will never reverse the effects fully

45
Q

What are some infections that can cause/worsen Bronchiectasis?

A

Pseudomonas Aeruginosa

Non-Tuberculous Mycobacteria (NTM)

46
Q

Why is Pseudomonas Aeruginosa very bad for Bronchiectasis?

A

Chronically colonises the patient making the inflammation, dilatation and mucus build up in airways worse

They produce a biofilm making it hard to eradicate

47
Q

How can Pseudomonas aeruginosa infection be treated?

A

Nebulised colomycin

48
Q

Why are Non-tuberculous mycobacteria sometimes missed?

A

Not picked up on routine sputum culture

49
Q

What are the main 2 treatment goals for Bronchiectasis?

A

Airways clearance of mucus
Medication (antiflammatories, antibiotics and Mucolytics)

50
Q

What is cystic fibrosis?

A

Genetic condition which is a particular form Bronchiectasis

Defect of chromosome 7 leads to problem in Cystic Fibrosis Conductance Regulator (CFTR)

51
Q

What is the pathology of cystic fibrosis?

A

Issue in expression of CFTR means less Cl- put out into surfaces so less water follows producing thick sticky mucus

52
Q

What can CF affect?

A

Many body systems and organs

53
Q

How is cystic fibrosis diagnosed?

A

Newborn screening
Sweat test (High Cl- levels in sweat)

54
Q

What can happen to CFTR in CF?

A

Not made
Gets stuck
Doesnt work properly
Not enough made
Gets degraded too quickly

55
Q

What is the drug that massively improves CF?

A

Kaftrio

56
Q

Why do patients who have COPD have more issue with exhalation that inhalation?

A

Obstruction in airway has less affect in inhalation since airways expand but in expiration, airways narrow so obstruction blocks whole airway

The loss of interstitium (Emphysema) leads to reduced radial traction so alveoli collapse more easily

57
Q

Why do patients with COPD often breathe through pursed lips?

A

Adds PEEP (Postive end expiratory pressure)

This helps keep the lungs and alveoli open at the end of expiration preventing their collapse

Resp (23 decks)

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