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KT > Resp COPD > Flashcards

Resp COPD Flashcards

1
Q

What is the definition of COPD?

A

Fixed airflow obstruction with minimal / no reversibility with bronchodilators

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2
Q

What are the risk factors for COPD?

A

Smoking
Occupation or environmental risk factors
Personal / family history of lung disease

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3
Q

Briefly describe the pathophysiology of COPD

A

Mucous gland hyperplasia
Chronic inflammation and fibrosis of small airways
Emphysema due to alveolar wall destruction
Thickened pulmonary arteriolar wall and remodelling

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4
Q

What is the consequence of mucous gland hyperplasia in COPD?

A

Chronic productive cough

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5
Q

What is the consequence of emphysema?

A

Irreversible enlargement of airspaces distal to terminal bronchiole leading to loss of elastic recoil and hyper inflated lungs

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6
Q

What is the consequence of thickened pulmonary arteriolar wall remodelling?

A

Increased pulmonary vascular resistance
Pulmonary hypertension
Impaired gas exchange

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7
Q

What are the clinical features of COPD?

A

Dyspnoea
Chronic cough
Decreased exercise tolerance
Wheeze

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8
Q

What are the signs of COPD?

A 
Increased respiratory rate
Hyperinflated / barrel chest
Prolonged expiratory time with pursed lip breathing
Use of accessory muscles
Quiet breath sounds with/out wheeze
Quiet heart sounds
Signs of cor pulmonale
Signs of CO2 retention
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9
Q

What investigations should be done in COPD?

A

Spirometry

Chest X ray

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10
Q

What spirometry results would suggest COPD?

A

FEV1 <80% of predicted or FEV1>80% of predicted with other respiratory symptoms
FEV1/FVC <0.7 after bronchodilation
Raised total lung volume, FRC and RV due to emphysema, air trapping and loss of elastic recoil

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11
Q

What would you expect to see on a CXR in COPD?

A

Hyperinflated lung fields with attenuation of peripheral vasculature
Flattened diaphragm

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12
Q

What are the differentials of COPD?

A 
Asthma
Congestive heart failure
Bronchiectasis
TB
Bronchiolitis
Upper airway dysfunction
Chronic sinusitis
Gastric oesophageal reflux disease
Lung cancer
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13
Q

What is the non-pharmacological management of COPD?

A

Smoking advice
Vaccination - pneumococcal and influenza
Pulmonary rehabilitation
Diet

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14
Q

What is the 1st line pharmacological treatment for mild-moderate COPD?

A

Short-acting beta 2 agonist e.g. salbutamol

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15
Q

What is the 2nd line pharmacological treatment for mild-moderate COPD?

A

SABA + long acting antimuscarinic such as braitus zonda inhaler

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16
Q

What is the 3rd line pharmacological treatment for mild-moderate COPD?

A

SABA + LAMA/long-acting beta2 agonist e.g. spiolto respimat

17
Q

What is the 1st line pharmacological treatment for severe COPD?

A

SABA + LAMA

18
Q

What is the 2nd line pharmacological treatment for severe COPD?

A

SABA + LAMA/LABA or LABA/ICS such as fostair

19
Q

Give an example of a mucolytic

A

Carbocysteine

20
Q

What should be included in a rescue pack to manage exacerbations?

A

Short acting bronchodilator
Oral corticosteroid e.g. prednisolone
Oral antibiotics e.g. amoxicillin or doxycycline

21
Q

Describe grade 0 on the MRC dyspnoea scale

A

No breathlessness except with strenuous activity

22
Q

Describe grade 1 on the MRC dyspnoea scale

A

Breathless hurrying on level or walking up a slight hill

23
Q

Describe grade 2 on the MRC dyspnoea scale

A

Has to walk slower than others on level ground due to breathlessness

24
Q

Describe grade 3 on the MRC dyspnoea scale

A

Stops for breath after few minutes on level ground

25
Q

Describe grade 4 on the MRC dyspnoea scale

A

Too breathless to leave house, breathless with dressing

26
Q

What are the infectious causes of COPD exacerbations?

A

Bacterial: haemophilus influenzae, streptococcus pneumoniae, Moraxella catarrhalis
Viral: rhinovirus, RSV, influenza, parainfluenza, coronavirus, human metapneumovirus & adenovirus

27
Q

What are the non-infectious causes of COPD exacerbations?

A

Pollution

Temperature decrease

28
Q

What are the symptoms of an acute exacerbation of COPD?

A 
Increased cough
Increased sputum volume &amp;/or purulence
Increasing dyspnoea or wheeze
Chest tightness
Fluid retention
29
Q

How would you assess exacerbation severity of COPD?

A 
RR
O2 saturations
Degree of air entry
Tachycardia
Peripheral perfusion
Conscious level
Mental state

KT (6 decks)

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