Respiraconservative 2 Flashcards
What is chronic obstructive pulmonary disease (COPD)?
Non-reversible long-term deterioration in air flow through the lungs, caused by damage to lung tissue
Describe the epidemiology of COPD
Symptoms usually present between 40-60
What is the main cause of COPD?
Smoking
What are 6 risk factors for COPD?
- Smoking2. Age3. Second-hand smoke exposure4. Occupational exposure (mining/dust/cottonwood)5. Pollution (heating fuel/outdoor pollutants)6. Genetics (A1AT deficiency)
Describe the pathophysiology of COPD
- Obstructed airflow through the airways increases the difficulty ventilating the lungs- = short of breath and prone to infection
What are the 2 main types of COPD?
- Chronic bronchitis2. Emphysema
What is chronic bronchitis?
Hypertrophy and hyperplasia of mucus glands and infiltration of chronic inflammation cells into the bronchi
What is emphysema?
Destruction of elastin layer in ducts, alveoli and respiratory bronchioles
What is alpha-1-antitrypsin (A1AT) and what does it do?
- Protease inhibitor made in the liver- Inhibits neutrophil elastase (enzyme that digests connective tissue)- Function to protect the lungs from damage caused by infection, inflammation and smoking
How does an A1AT deficiency affect the liver?
- Mutant A1AT builds up- Causes tissue damage= cirrhosis and HCC (hepatocellular carcinoma)
How does an A1AT deficiency affect the lungs?
- Lack of normal A1AT- = excess protease enzymes- Lung tissue attacked
What is IE COPD?
Infective exacerbations COPD - when patients experience exacerbations due to infection
Describe the pathophysiology of chronic bronchitis
- Hypertrophy and hyperplasia of mucus glands- Infiltration of chronic inflammation cells (e.g. macrophages/lymphocytes) into the bronchi- Causes mucous secretion, ciliary dysfunction and a narrowed lumen
Describe the pathophysiology of emphysema
- Destruction of elastin layer in ducts, alveoli and respiratory bronchioles- Air trapping distal to blockage, causing bullae- Centriacinar emphysema is the most common (affects respiratory bronchioles - due to smoking)
What are 7 typical presentations of COPD?
- Typically a long-term smoker2. Finger clubbing3. Shortness of breath4. Cough5. Sputum production6. Wheeze7. Recurrent respiratory infections
How does IE COPD present?
Acute worsening of symptoms
What are 8 clinical presentations of chronic bronchitis?
- Chronic productive cough with purulent sputum2. Dyspnoea3. Cyanosis (may develop pulmonary HTN)4. Peripheral oedema5. Obesity6. Haemoptysis7. Rhonchi (large airway sounds)8. Wheezing
What are 8 clinical presentations of emphysema?
- Dyspnoea/tachypnoea2. Minimal cough3. Pink skin, pursed-lip breathing4. Accessory muscle use5. Cachexia (weakness/wasting of body)6. Hyperinflation (barrel chest)7. Weight loss8. Quiet chest
What are 6 clinical presentations of an A1AT deficiency in the liver?
- Tiredness2. Loss of appetite3. Weight loss4. Oedema5. Jaundice6. Haematemesis/blood in stool
What are 5 clinical presentations of an A1AT deficiency in the lungs?
- SOB2. Excessive cough with sputum production3. Wheeze4. Decreased exercise capacity/persistent fatigue5. Chest pain (worse on inhalation)
Describe the MRC dyspnoea scale
Allows patients to describe the extent to which their breathlessness affects their mobility:- Grade 1 = breathless on strenuous exercise- Grade 2 = breathless on walking up hill- Grade 3 = breathless that slows on flat- Grade 4 = stop to catch breath after 100m walking on flat- Grade 5 = unable to leave the house due to breathlessness
What are 7 investigations for patients with COPD?
- Spirometry = FEV1/FVC <0.72. FEV1 (stage 1 >80%, stage 4 <30% predicted value)3. CXR (exclude lung cancer and other pathologies)4. FBC (chronic hypoxia –> polycythaemia)5. BMI (weight loss)6. ECG (if cardiac concerns)7. Serum A1AT levels
What are 4 investigations for patients with IE COPD?
- ABG:- CO2 retention –> acidosis- T1RF = normal pCO2 + low pO2- T2RF = high pCO2 + low pO22. CXR3. FBC4. U&E
What are 4 investigations for patients with an A1AT deficiency?
- Serum A1AT levels (low)- Liver biopsy (cirrhosis, mutant protein in hepatocytes)- Genetics (A1AT mutant gene)- CT thorax (bronchiectasis, emphysema)