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Semester 3 - Respiratory > Session 6 - COPD, Lower Respiratory Tract Infection and Pneumonia > Flashcards

Session 6 - COPD, Lower Respiratory Tract Infection and Pneumonia Flashcards

1
Q

Give a brief outline of what COPD actually is

A

• 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

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2
Q

What is airflow obstruction?

A
  • Reduced FEV1

* Reduced FEV1/FVC ratio

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3
Q

Outline the epidemiology of COPD

A
  • 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
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4
Q

What is COPD caused by?

A
  • 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)
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5
Q

What is a less common cause of emphysema?

A

• Inherited deficiency of a1-antitrypsin

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6
Q

Two ways in which inflammation causes pathology of COPD

A
  • Inflammation amplified by host factors
    • Oxidative stress
    • Proteinases (followed by various repair mechanisms)
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7
Q

Give four changes in the airways in patients with COPD

A
  • Changes in large airway
    • Changes in small airways in COPD
    • Changes in lung parenchyma
    • Changes in pulmonary arteries
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8
Q

Give three main causes of COPD?

A
  • Smoking
    • Environmental factors
    • Genetic predisposition
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9
Q

What are the mechanisms of COPD?

A
  • Airway and systemic inflammation
    • Alveolar destruction
    • Hyperinflation
    • Respiratory muscle ineffiency
    • Skeletal muscle dysfunction
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10
Q

What are the main consequences of COPD?

A
  • Airway obstruction
    • Dyspnoea
    • Exercise limitation
    • Nutritional delpletion
    • Respiratory failure
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11
Q

What are five impacts of COPD?

A
  • Mobility
    • Health status
    • Moos
    • Hospitalisations
    • Death
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12
Q

How does COPD make itself worse?

A
  • COPD -> Breathlessness -> Reduced exercise capacity -> Poor health related quality of life
    • Breathlessness reduces exercsise capacity
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13
Q

Give four symptoms of COPD

A

• Productive cough
○ White or clear sputum
• Wheeze
• Breathlessness

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14
Q

Give four signs of COPD

A

• No signs or quiet wheezes
• Hyperventilation with prolonged expiration
○ Expiratory airflow limitation
• accessory muscles of respiration are used
• Hyperinflation of the lung

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15
Q

What are the five main factors which you must assess to determine a diagnosis of COPD

A 
• 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?)
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16
Q

What is the MRC dyspnoea scale?

A
  • 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
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17
Q

What is spirometry?

A
  • 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
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18
Q

What happens to respiratory rate, pO2 and CO2 in Type 1 Respiratory failure

A
  • Respiratory rate increases
    • pO2 decreases
    • CO2 decreases
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19
Q

What happens to respiratory rate, pO2 and CO2 in type 2 respiratory failure

A
  • Respiratory rate increases
    • pO2 decreases
    • CO2 increases
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20
Q

Give four principles of the management of respiratory failure?

A
  • Correct underlying cause
    • Supplementary oxygen
    • Support ventilation
    • Secretion management
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21
Q

What occurs in oxygen therapy?

A

• O2 given to patients to increase O2 saturation and alleviate symptoms.

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22
Q

What is O2 therapy a treatment for?

A

• Hypoxaemia, not breathlessness

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23
Q

Why is O2 therapy useful as a treatment?

A
  • Long term
    • Portable
    • Intermittent
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24
Q

Can COPD be cured?

A

• No, only managed

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25
Q

Give 6 ways in which COPD can be treated

A
  • Smoking cessation
    • Drug therapy
    • Oxygen therapy
    • Pulmonary rehabilitaton
    • A1 - antitrypsin replacement
    • Treat co-morbid conditions
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26
Q

How can smoking cessastion help with COPD?

A
  • Prevents future worsening of the condition

* Adds years onto life

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27
Q

How does drug therapy assist with COPD treatment?

A

• Used for short term management of exacerbation and the long term relief of symptoms

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28
Q

What drugs are used in COPD?

A 
• Bronchiodilators
		○ B2 antagonist
	• Corticosteroids 
		○ Immunosupressive
	• Antibiotics
		○ Shortens exacerbations
		○ Given as soon as sputum turns yellow or green
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29
Q

How does oxygen therapy help?

A

• Increase blood oxygen saturation by administering oxygen

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30
Q

How does pulmonary rehabilitation help?

A
  • Exercise training can modestly increase exercise capacity

* Regular training periods can be used at home

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31
Q

What physiological effects does pulmonary rehabillitation have?

A 
• Physiological 
		○ Muscle mass
		○ Mitochondrial density
	• Health 
		○ Improved activity
		○ Reduced care costs
	• Increases patients MRC grade by 1 point if done effectively
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32
Q

What can you do in hospitals to keep patients physically fit?

A

• Get them to the gym lad

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33
Q

How does a1-antitrypsin replacement work

A

• Replaces if deficient

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34
Q

What co-morbidities must be treated to fully effect improvement in COPD?

A
  • Cardiac
    • Metabolic
    • Nutritional
    • Osteoporosis
    • Anxiety/depression
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35
Q

What is exacerbation of COPD?

A
  • Worsening of previous stable condition
    • Increased wheeze, dyspnoea, sputum volum & colour
    • Chest tightness
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36
Q

What is NIPPV (Non-invasive positive pressure ventilation)in COPD?

A

• Acute exacerbation
○ Causes severe acidosis
○ Confusion

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37
Q

What surgery can be used to reduce effects emphsema?

A

• Lung volume reduction surgery

38
Q

How do you calculate oxygen delivery?

A

• SaO2 x Hb x Cardiac Output

39
Q

What is the definition of respiratory failure at sea levels in PaO2

A
  • <7.3 kPa PaO2

* 6.5 kPa pCO2 (may or may not be present)

40
Q

Give four pulmonary causes of respiratory failure

A
  • Hypoventilation
    • Ventilation/perfusion imbalnce
    • Alveolar/capillary diffusion block
    • True shunt
41
Q

How does hypoventilation cause respiratory failure?

A

Raised PaCO2

42
Q

How is ventilation/perfusion imbalance caused

A
  • Asthma

* Pulmonary embolism

43
Q

How is a alveolar/capillar diffusion block caused?

A
  • Pulmonary oedema

* Fibrosing alveolitis

44
Q

What is a true shunt?

A

• VSD and malformation

45
Q

What does pO2 need to be to avoid hypercapnia?

A

• 88-92%

46
Q

Outline four of the most common normal flora of the respiratory tract

A
  • Viridans streptococci
    • Neisseria spp
    • Anaerobes
    • Candida spp
47
Q

Give five less common flora in the URT

A
  • Streptococcus pneumonia
    • Streptococcus pyogenes
    • Haemophillus influenza
    • Pseudomonas
    • E. coli
48
Q

Give three of the main natural defences of the respiratory tract

A
  • Cough and sneezing reflex
    • Muco-ciliary clearance mechanisms
    • Respiratory mucosal immune system
49
Q

What are the muco-ciliary clearance mechanisims?

A
  • Ciliated columnar epithelium

* Nasal haris

50
Q

What is the respiratory muscoal immune system?

A
  • Lymphoid follicles of the pharynx and tonsils
    • Alveolar macrophages
    • Secrete IgA and IgG
51
Q

List 5 upper respiratory tract infections

A
  • Rhinitis
    • Pharyngitis
    • Epiglottitis
    • Laryngitis
    • Sinusitis
52
Q

What are URT infections most commonly caused by?

A 
• Viruses
		○ Rhinovirus
		○ Corona virus 
		○ Influenze
		○ Respiratory Syncytial virus
53
Q

What do bacterial super-infections cause?

A 
• Common with sinusitis and otitis media
• Can lead to 
	○ Mastoiditis
	○ Meningitis
	○ Brain abscess
54
Q

What is pneumonia?

A

• General term denoting inflammation of the gas exchnage system of the lung, usually due to infection. Pneumonia is therefore an infection of the lung parenchyma.

55
Q

What is lung inflammation due to other causes such as physical or chemical damage called?

A

Pneumonitis

56
Q

What is lobar pneumonia?

A
  • Pneumonia localised to a particular lobe of the lung

* Most often due to streptoccocus pneumoniae

57
Q

What is broncho pneumonia

A
  • Pneumonia that is diffuse and patchy. Infection starts in the airways and spreads to adjacent alveoli and lung tissue.
    • Streptoccous pneumonia, Haemophilus influenza, Staphylococcus aureus, anaerobes
58
Q

What is aspiration pneumonia

A
  • Aspiration of food, drink, saliva or vomit can lead to pneumonia.
    • Most likely individuals with altered level of conciousness due to anathessia, alcohol or drug abuse - Also problems swallowing
    • Oral flora and anaerobes
59
Q

What is interstitial pneumonia?

A
  • Inflammation of the interstiticium of the lung

* Alveolar epithelium, pulmonary capillary endothelium, basement membrane, perivascular and perilymphatic tissues)

60
Q

What is chronic pneumonia?

A

• Inflammation of the lungs that persists for an extended period of time

61
Q

What is the pathology of pneumonia?

A
  • Fluid filled air spaces and consolidation

* Gas exchange is impared - Results in systemic and local symptoms

62
Q

In what four ways is pneumonia classified?

A
  • By clinical setting - Community/hospital acquired
    • By presentation - Acute/sub acute and chronic
    • By organism - Bacteria/Viral/fungal
    • By lung pathology - Lobar pneumonia/bronchopneumonia/interstitial pneumonia
63
Q

What are the three most common bacterial causes of community acquired infection

A
  • Streptococcus pneumoniae
    • Haemophilus influenza
    • Klebsiella pneumoniae
64
Q

Give three atypical bacteria involved in community based pneumonia

A
  • Chlamydia pneumophillia
    • Mycoplasma pneumoniae
    • Legionelle pneumophilia
65
Q

What are the three most comon causes of hospital acquired baceria/

A
  • Pseudomonas
    • Staphylococcus aureus
    • MRSA
66
Q

What are the two most common bacterial causes of aspiration pneumonia

A
  • Anaerobes

* Oral flora

67
Q

What are the associated features of S. Pneumniae

A

• Elderly, co-morbidities, acute onset , high fever, pleuritic chest pain

68
Q

What are the associated features of H. Influenza

69
Q

What are the associated features of legionella

A
  • Recent travel
    • Younger patient
    • Smoker
    • Illness
    • Multisystem involvement
70
Q

What are the associated features of mycoplasm pneumonia

A
  • Young
    • Prior to antibiotics
    • Extra-pulmonary involvement (haemolysis, skin and joint)
71
Q

What are the associated features of staph aureus pneumonia

A
  • Post viral

* Intravenous Drug User

72
Q

Give an associated feature of chalmydia pneumonia

A

• Contact with birds

73
Q

Give an associated feature of coxiella pneumonia

A

• Animal contact

74
Q

Give an associated feature of klebsiella pneumonia

A

• Thrombcytopenia, leucopenia

75
Q

Give an associated feature of s.milleri

A
  • Dental infections
    • Abdominal source
    • Aspiration
76
Q

Outline the symptoms always present in pneumonia

A
  • Fever
    • Malaise
    • Productive cough
    • Pleuritic chest pain
    • Breathlessnes
77
Q

What will the sputum of someone with pneumonia look like?

A

• Purulent or rusty coloured

78
Q

How quick is the onset of pneumonia, and what types are the fastest?

A
  • Very rapid onset

* Pneumoccoccal or staphylococcal, fatal outcome

79
Q

Give some specific features of hospital acquired pneumonia

A
  • Pneumonia occuring 48 hours after hospital
    • Make up 15% of all hospital acquired infections
    • Common in ventilated post surgical patients
80
Q

How can the symptoms of pneumonia be assessed?

A

• CURB 65 score - presence of two or more indication for hospital treatment, patients with higher scores may require ICU treatment.
○ C - new mental Confusion (AMT 7mmol/l
○ R - Respiratory rate >30 per minute
○ B - Blood pressure (systolic 65

81
Q

What does CURB 65 score assess?

A

• The severity, NOT the resistance of the pneumonia

82
Q

Where are samples collected from to investigate pneumonia?

A
  • Sputum
    • Nose and throat swabs
    • Endotracheal aspirate
    • Broncho alveolar lavage fluid
    • Blood culture
83
Q

What microbiological investigations can be done for pneumonia?

A 
• Macroscopic 
	○ Sputum, purulent, blood stained
• Microscopy
	○ Gram staining, acid fast
• Culture
	○ Bacteria and viruses
• PCR
	○ Respiratory viruses
• Antigen detection
	○ Legionella
• Antiobody detection 
	○ Serology
84
Q

What is an opportunistic infection?

A

• Pathogens infecting immunosupressed hosts

85
Q

Give an example of 4 different types of opportunistic pathogen

A
  • Viruses - Cytomegalovirus
    • Bacteria - Mycobacterium avium intracellulare
    • Fungi - Aspergillus candida, pneumocystitis jirovecil
    • Protozoa - Toxoplasmosis
86
Q

Outline management of pneumonias

A 
• Oral fluid /IV fluid if severe 
		○ Avoids dehydration
	• Anti-pyretic drugs
		○ Reduce fever and malaise
	• Stronger analgesics
		○ Deal with the pain
	• Oxygen 
		○ If there is cyanosis 
	• Specific anti-biotics
87
Q

What kind of anti-biotics is a community acquired pneumonia treated with

A

• Pneumococcus, which is sensitive to penicillin (antibiotics which affect the cell wall)

88
Q

What kind of anti-biotics is hospital acquired pneumonia treated with?

A

• Target organism is more likely to be gram -‘ve, making it necessary to use antibiotics that cover these organsims

89
Q

Give the three main outcomes of pneumonia

A
  • Resolution
    • Complications
    • Death
90
Q

hat is involved in resolution of pneumonia?

A

Organisation (fibrous scarring)

91
Q

What are three possible complication of pneumonia?

A
  • Lung abscess
    • Bronchiectasis
    • Empyema (pus in pleural cavity)
92
Q

How can pneumonia be prevented?

A

• Immunization
○ Flu vaccine, given anually to high risk patients
○ Pneumococcal vaccine - two vaccines
• Chemoprophylaxis
○ Oral penicillin/erthromycin to patients with high risk of lower respiratory tract infections
○ Asplenia, dysfunctional spleen, immunodefiency

Semester 3 - Respiratory (18 decks)

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