Session 6 - COPD, Lower Respiratory Tract Infection and Pneumonia Flashcards
Give a brief outline of what COPD actually is
• Characterised by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways, which does not change markedly over several months
What is airflow obstruction?
- Reduced FEV1
* Reduced FEV1/FVC ratio
Outline the epidemiology of COPD
- 89% of the population is unaware
- 3.7 million affected in the UK
- 1 million symptomatic
- 30,000 deaths
- 1 million hospital inpatient days/year
What is COPD caused by?
- Abnormal inflammatory response of the lung to noxious particles or gases
- Noxious particles can come from cigarette smoke or atmospheric pollutants (not just cigarettes! Manual workers, indoor cooking fire)
What is a less common cause of emphysema?
• Inherited deficiency of a1-antitrypsin
Two ways in which inflammation causes pathology of COPD
- Inflammation amplified by host factors
- Oxidative stress
- Proteinases (followed by various repair mechanisms)
Give four changes in the airways in patients with COPD
- Changes in large airway
- Changes in small airways in COPD
- Changes in lung parenchyma
- Changes in pulmonary arteries
Give three main causes of COPD?
- Smoking
- Environmental factors
- Genetic predisposition
What are the mechanisms of COPD?
- Airway and systemic inflammation
- Alveolar destruction
- Hyperinflation
- Respiratory muscle ineffiency
- Skeletal muscle dysfunction
What are the main consequences of COPD?
- Airway obstruction
- Dyspnoea
- Exercise limitation
- Nutritional delpletion
- Respiratory failure
What are five impacts of COPD?
- Mobility
- Health status
- Moos
- Hospitalisations
- Death
How does COPD make itself worse?
- COPD -> Breathlessness -> Reduced exercise capacity -> Poor health related quality of life
- Breathlessness reduces exercsise capacity
Give four symptoms of COPD
• Productive cough
○ White or clear sputum
• Wheeze
• Breathlessness
Give four signs of COPD
• No signs or quiet wheezes
• Hyperventilation with prolonged expiration
○ Expiratory airflow limitation
• accessory muscles of respiration are used
• Hyperinflation of the lung
What are the five main factors which you must assess to determine a diagnosis of COPD
• History ○ Include MRC dyspnoea scale • Chest X-ray ○ To rule out lung cancer • FEV1 ○ Reduced FEV1 ○ Reduced FEV1/FVC ratio • Other lung function tests ○ Lung volumes, loop • High resolution CT scan ○ Detect emphysema (bola?)
What is the MRC dyspnoea scale?
- Not troubled by breathlessness except on strenuous exercise - 1
- Short of breath when hurrying or walking up a slight hill - 2
- Walks slower than contemporaries on level ground because of breathlessness, or has to sop for breath when walking at own pace
- Stops for breath after walking about 100m or after a few minutes one level ground - 4
- Too breathless to leave the house, or breathless when dressing or undressing - 5
What is spirometry?
- Patient fills their lungs from the atmosphere and breathes out as far and fast as possible through a spirometer
- Simple spirometery allows measurement of many lung volumes and capacities
What happens to respiratory rate, pO2 and CO2 in Type 1 Respiratory failure
- Respiratory rate increases
- pO2 decreases
- CO2 decreases
What happens to respiratory rate, pO2 and CO2 in type 2 respiratory failure
- Respiratory rate increases
- pO2 decreases
- CO2 increases
Give four principles of the management of respiratory failure?
- Correct underlying cause
- Supplementary oxygen
- Support ventilation
- Secretion management
What occurs in oxygen therapy?
• O2 given to patients to increase O2 saturation and alleviate symptoms.
What is O2 therapy a treatment for?
• Hypoxaemia, not breathlessness
Why is O2 therapy useful as a treatment?
- Long term
- Portable
- Intermittent
Can COPD be cured?
• No, only managed
Give 6 ways in which COPD can be treated
- Smoking cessation
- Drug therapy
- Oxygen therapy
- Pulmonary rehabilitaton
- A1 - antitrypsin replacement
- Treat co-morbid conditions
How can smoking cessastion help with COPD?
- Prevents future worsening of the condition
* Adds years onto life
How does drug therapy assist with COPD treatment?
• Used for short term management of exacerbation and the long term relief of symptoms
What drugs are used in COPD?
• Bronchiodilators ○ B2 antagonist • Corticosteroids ○ Immunosupressive • Antibiotics ○ Shortens exacerbations ○ Given as soon as sputum turns yellow or green
How does oxygen therapy help?
• Increase blood oxygen saturation by administering oxygen
How does pulmonary rehabilitation help?
- Exercise training can modestly increase exercise capacity
* Regular training periods can be used at home
What physiological effects does pulmonary rehabillitation have?
• Physiological ○ Muscle mass ○ Mitochondrial density • Health ○ Improved activity ○ Reduced care costs • Increases patients MRC grade by 1 point if done effectively
What can you do in hospitals to keep patients physically fit?
• Get them to the gym lad
How does a1-antitrypsin replacement work
• Replaces if deficient
What co-morbidities must be treated to fully effect improvement in COPD?
- Cardiac
- Metabolic
- Nutritional
- Osteoporosis
- Anxiety/depression
What is exacerbation of COPD?
- Worsening of previous stable condition
- Increased wheeze, dyspnoea, sputum volum & colour
- Chest tightness
What is NIPPV (Non-invasive positive pressure ventilation)in COPD?
• Acute exacerbation
○ Causes severe acidosis
○ Confusion