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303: Medicine > Obstructive lung disease > Flashcards

Obstructive lung disease Flashcards

1
Q

COPD definition

A

Irreversible progressive disease state causing airflow limitation in lungs.

Causes
- Emphysema
- Chronic bronchitis
- Small airway fibrosis

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2
Q

Pathophysiology

A

Chronic inflammation affecting;
- Central and peripheral airways
- Lung parenchyma, alveoli and vasculature.
- Inflammatory cells stimulated by inhaled stimuli: macrophages, neutrophils

Pathological changes in lungs
- Narrowing/ remodelling of airways
- Increased globet cells
- Enlarged mucus secreting glands in central airways
- Vascular bed changes

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3
Q

COPD risk factors

A

Tobacco smoking
- Most common

Indoor air pollution

Alpha-1 antitrypsin deficiency

Occupational exposures
- Vapours
- Gases
- Dusts
- Fumes

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4
Q

Alpha-1 antitrypsin deficiency
- Pathology
- Genetics

A

Enzyme is involved in inhibitng neutrophil elastase (protease inhibitor) from breaking down alveoli.
- Causes emphysema, liver cirrhosis

Genetics
- Autosomal dominant

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5
Q

Chronic bronchitis
- Description, pathology
- Presentation

A

Productive cough lasting a least 3 months in TWO consecutive years.
- Inflammation and irritation of airways leafs to overproduction of mucus from goblet cells
- Narrowing of the airways, limiting airflow leads to COPD

Presentation
- Chronic, productive cough, typically worse after awakening
- Colourless sputum.
- Recurrent infections
- Dyspnoea

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6
Q

Emphysema
- Description
- Pathology
- Causes

A

Breakdown of alveolar tissue
- Causes pneumatosis (air filled cavities)
- Reduces surface area of gaseous exchange

Causes
- Smoking
- Alpha-1 antitrypsin deficiency

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7
Q

COPD features
- Clinical features

A

Cardinal features
- Progressive dyspnoea: start off exertional, then at rest.
- Productive, chronic cough
- Wheeze
- Frequent winter bronchitis

Other features
- Weight loss, cachexia
- Fatigue
- Chest pain
- Ankle swelling (cor pulmonale)
- Haempotsis
- Hands: clubbing, cyanosis, tremor, asterixis.
- Hyper-resonance chest
- Chest wall changes: barrel chest,

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8
Q

Diagnostic investigation for COPD

A

First line= Spirometry
- Obstructive/ mixed pattern
- FEV1< 80
- FEV1/ FVC ration < 70

Post-bronchodilator spirometry= confirms COPD

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9
Q

Conservative management of COPD

A

Smoking cessation

Pulmonary rehab

Influenza vaccine/ pneumococcal vaccine

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10
Q

Complications of COPD

A

Type 2 resp failure

Secondary polycythemia
- Due to chronic hypoxaemia

Cor-pulmonale

Bronchiectasis

Osteoporosis
- Steroid, smoking

Mental health

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11
Q

Medical management for COPD

A
  1. SABA or SAMA as needed
  2. Asthma features
    - LABA and ICS

Non-asthmatic
- LABA AND LAMA

  1. LABA, LAMA, ICS
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12
Q

GOLD Groups of COPD (A-D)

A

Group A
- Few symptoms
- low risk of exacerbation

Group B
- More symptoms
- Low exacerbation risk

Group C
- Few symptoms
- High exacerbation risk

Group D
- High risk, more symptoms

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13
Q

COPD stages
- 1-4, according to FEV1

A

Stage 1: mild
- FEV1> 80

Stage 2: Moderate
- FEV1 = 50-79%

Stage 3: Severe
- FEV1= 30-49%

Stage 4: Very severe
- FEV1 <30

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14
Q

SABA used for COPD

A

Salbutamol
- Bronchodilator
- First line for Group B

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15
Q

LABA used for COPD

A

Salmeterol, formoterol
- used when symptoms persist with SABA

Add LAMA if symptoms still persist
- Add ICS if asthmatic features and symptoms persist

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16
Q

LAMA used for COPD

A

Long acting antimuscarinic
- AcH causes smooth muscle contraction, so inhibition causes bronchodilation

Examples
- Ipratropium bromide (Atrovent)
- Glycopyronium
- Alclidinium

17
Q

ICS used for COPD

A

USed in patients with asthma features
- Beclamethasone

18
Q

Roflumilast

A

Phosphodiesterase-4 inhibitors
- Anti-inflammatory drug
- enzyme degrades cAMP

Used to prevent further COPD exacerbations

19
Q

Acute exacerbation of COPD
- Causes

A

Potentially life-threatening exacerbation of COPD
- Causing deterioation of symptoms

Causes
- Respiratory infections: Strep pneumoniae, H influenzae.
- Viral infections: rhinovirus, influenza, RSV
- Pollutants

20
Q

Management of Acute exacerbation of COPDCOPD

A

Usual ABCDE approach

Oxygen
- Aim for 88-92%, can give high flow if very hypoxic initially

Nebulised salbutamol
- Progress to ipratropium if Salbutamol not working
- IV theophylline if above fails

Steroids orally
- Prednisolone
- IV hydrocortisone

IV access for anitbiotics and fluids

Antibiotics
- If purulent sputum production/ signs of pnuemonia
- First line PO: amoxicillin, doxycycline, clarithromycin

  • Second line: Co-amoxiclav, levofloxacin, trimethroprim
  • IV antibiotics: Amoxicillin, co-amoxiclav, clarithromycin, trimethoprim, Tazocin
21
Q

Additional investigations for COPD

A

Chest XR= excludes other pathology
- Increased AP ratio/ hyperinflation
- Flattened diaphragm
- Hyperlucent lungs

FBC
- Anaemia + polycythemaia

BMI

Blood gas
- Hypoxia
- Type 2 resp failure

ECG/ echo
- assess for cardiac disease/ pulmonary hypertension

Serum alpha-1 antitrypsin (if no smoking history)

22
Q

What scale is used to assess breathlessness in COPD

A

MRC scale

23
Q

First-line pharmacological management of COPD

A

SABA
- used for dyspnoea and exercise intolerance

24
Q

When is LAMA + LABA indicated in COPD

A

In non-asthmatic features +

Symptomatic despite smoking cessation & SABA

25
Q

Indications for LAMA+LABA+ICS in COPD

A

In those taking LABA+ICS/LAMA who have
- severe exacerbation requiriing hospitalisation
- 2+ moderate exacerbations in a year.

26
Q

Oral therapies in COPD and their indications

A

Corticosteroids

Theophylline
- After using SABA and LABA
- Or when inhaled is not appropiate

Mucolytics
- Chronic sputum production

27
Q

Indications for long term oxygen therapy in COPD

A

Non-smoker

PaO2 <7.3 kPa OR

7.3-8kPa AND
- Polycythemia
- Peripheral oedema
- Pulmonary
hypertension

28
Q

What vaccinations should be offered in COPD

A

Pneumococcal

Annual flu

29
Q

Indications for oral prophylactic antibiotic therapy in COPD

A
  • Non-smoker
  • Optimal pharamcological therapy
  • Vaccinated
    AND
  • frequent exacerbations (4+/ year with sputum)
  • Hospitalised exacerbation
30
Q

What antibiotic is used as prophylactic antibiotic therapy in COPD

A

Azithromycin 250 mg 3x/ week

31
Q

Baseline tests before starting azithromycin

A

ECG (QT)

LFTs

32
Q

Gold standard investigation for bronchiectasis

A

High resolution CT Chest
- Bronchial wall thickening
- Signet ring sign

303: Medicine (19 decks)

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