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PM2C: Therapeutics and Patient Care: Summer > Respiratory: COPD > Flashcards

Respiratory: COPD Flashcards

1
Q

What does each letter represent in COPD and describe them?

A
  1. Chronic: progressive and long lasting
  2. Obstructive: Narrowing of airways that cause airflow limitation
  3. Pulmonary: Small airways and/or alveoli destruction
  4. Disease: Multicomponent illness with extra pulmonary effects

Chronic Obstructive Pulmonary Disease

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2
Q

What causes airflow limitation?

A

Mixture of small airway disease and parenchymal destruction: chronic bronchitis and emphysema

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3
Q

Describe what COPD is mainly?

A
  1. Air flow limitation that isn’t fully reversible

2. Progressive and associated with abnormal inflammatory response of the lungs to noxious particles and gases

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4
Q

What are the risk factors for COPD?

A
  1. Smoking (80% of COPD)
  2. Environmental pollution
  3. Genetic factor
  4. Occupational Exposure
  5. Frequent infections of airways
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5
Q

What are the symptoms of COPD?

A
  1. Progressive and exertional breathlessness (dyspnea)
  2. Chronic Cough
  3. Sputum production
  4. Wheezing and chest tightness
  5. Frequent winter bronchitis
  6. Upper respiratory infection (constant sputum)
  7. Pulmonary Hypertension
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6
Q

What are symptoms of severe COPD?

A
  1. Weight Loss
  2. Anorexia
  3. Ankle swelling
  4. Depression and anxiety
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7
Q

What is chronic bronchitis?

A

Inflammation of the central airways (trachea and bronchi) and the smaller airways (bronchioles)

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8
Q

What is Emphysema?

A

Persistent inflammation that leads to destruction of the walls of the alveoli at the small airways

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9
Q

Describe the symptoms of chronic bronchitis?

A

Persistant cough with sputum production for at least 3 months of the year for 2 consecutive years

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10
Q

Describe how chronic bronchitis causes obstruction of the airways?

A
  1. Hypertrophy and hyperplasia occur to the mucus secreting glands and smooth muscle in smaller airways
  2. Small airways become obstructed by intraluminal mucus
  3. Causes mucosal oedema and airway wall fibrosis
  4. Obstruction and mucus increase resistance to airflow
  5. Causes chronic viral and bacterial colonisation in retained mucus
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11
Q

Describe how Emphysema works?

A
  1. Permanent enlargement of the air spaces distal to the terminal bronchiole
  2. Destruction of the parenchyma decreases area for gas exchange and lung elasticity
  3. Hypertrophy of capillaries reduces ability to absorb oxygen and increases blood pressure
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12
Q

Describe the pathogenesis of COPD and how it leads to lung inflammation and damage?

A

Inflammation:
1. Neutrophils (proteinases and leukotrienes)

  1. Macrophages
    (cytokines and chemokines)
  • Proteinase inbalance
    Alpha 1 antitrypsin deficit
  • Oxidativone stress: impairment of histone deacetylase
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13
Q

How do you diagnose COPD?

A
  1. Combination of history and physical
  2. Considered in patients over the age of 35 (with risk factor and respiratory symptoms)
  3. Presence of air flow obstruction (checked using post bronchodilator spirometry)
  4. Health professionals should involve the care of people and have access to spirometry know how to analyse results
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14
Q

How do you manage COPD?

A
  1. Assess symptoms and establish diagnosis
    - Stop smoking
    - Healthy lifestyle
    - immunisation
  2. Treat obstruction
    - Bronchodilators
    - Corticosteroids
    - Inhaled combination therapy
  3. Assess for hypoxia
    - Long term oxygen therapy
    - Pulmonary rehabilitation program
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15
Q

What does smoking do overtime to the FEV1 levels?

A

Decreases it overtime

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16
Q

What should you immunise COPD patients with and why?

A
  1. Pneumococcal vaccination and annual influenza vaccination

2. COPD patients have an increased risk of developing influenza or pneumococcal pneumonia

17
Q

What should you use in terms of bronchodilators and corticosteroids to reduce breathlessness and exercise limitation?

A
  1. Short acting beta 2 adrenergic agonists (SABA)

2. Short acting antimuscarinic (SAMA)

18
Q

What should you use in terms of bronchodilators and corticosteroids to reduce exacerbations or persistent breathlessness?

A
  1. Long acting beta 2 adrenergic agonists (LABA)

2. Long acting anti-muscarinic (LAMA)

19
Q

What should you use in terms of bronchodilators and corticosteroids to reduce persistent exacerbations and breathlessness?

A
  1. Long acting beta 2 adrengeric agonists (LABA) for extra symptom control with inhaled corticosteroid (ICS)
  2. Alongside Long acting muscarinic
20
Q

Give examples of short and long acting antimuscarinic (anticholinergic) drugs?

A
  1. Ipratropoum bromide
  2. Tiotropium
    - Spiriva HandiHaler
    - Spiriva Respimat
21
Q

What do the M1 receptors mediate?

A

Bronchodilation by the release of a relaxing agent from respiratory epitheliaa or pulmonary nerves

22
Q

What do the M2 auto receptors?

A

Post ganglionic cholinergic nerves provide negative feedback to reduce acetylcholine release

23
Q

What do the M3 receptors work on and mediate?

A
  1. Works on airway smooth muscle cells and glands

2. Mediate broncho-constriction and mucus secretion

24
Q

What are the oral therapy available for managing COPD?

A
  1. Oral corticosteroids (low dose and monitor)
  2. Theophylline (slow release formulation)
  3. Oral mucolytic therapy
25
Q

When is it seen as Exacerbation?

A
  1. Worsening breathlessness cough

2. Increase sputum production with change in colour

26
Q

How do you mange COPD exacerbation with inhaled therapy?

A

Increased dose of short acting bronchodilators

27
Q

How do you mange COPD exacerbation with oral therapy?

A
  1. Systemic corticosteroids
  2. Antibiotics
    - Empirical
    - Exacerbations of COPD with purulent sputum
28
Q

How do you manage COPD exacerbation with intravenous therapy?

A

Theophylline and methylxanthines

29
Q

What are 4 ways of managing COPD exacerbation?

A
  1. Inhaled Therapy
  2. Oral Therapy
  3. Intravenous Therapy
  4. Ventilation and oxygen therapy
30
Q

What are the clinical benefit in COPD?

A
  1. Reduce but do not suppress lung inflammation and secretion of inflammatory proteins
  2. Reduce incidence of exacerbations- give high instance of pneumonia (immune suppression)
  3. Licensed in UK in combination of LABA
31
Q

What are the non pharmacological options for COPD?

A
  1. Pulmonary rehabilitation
    (Exercise training, respiratory muscle training, chest physical therapy, breathing techniques)
  2. Oxygen therapy
  3. Use of inhaled therapy
32
Q

What are the surgical therapies for COPD?

A
  1. Bullectomy or lung volume reduction surgery

2. Lung transplantation

PM2C: Therapeutics and Patient Care: Summer (25 decks)

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