W2: MC (Part 2) Flashcards
COPD is characterised by:
Persistent respiratory symptoms and airflow limitation
In 2022 COPD was the …… leading cause of total disease burden in Australia. What percentage of all deaths?
4th leading cause
4.1%
COPD is an obstructive or restrictive disease?
Obstructive
(Due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases)
In COPD the most common respiratory symptoms include:
Dyspnoea
Cough
Sputum production
What age group has the highest percentage of COPD patients?
- Men
- Age 65-74 & 75 +
List 5 risk factors for COPD
- Tobacco smoke: cigarette & passive smoking
- Indoor air pollution
- Occupational exposures: dusts & chemical agents, fumes
- Outdoor air pollution
- Genetic factors
- Age and gender
- Lung growth and development
- Socioeconomic status
- Asthma and airway hyper-reactivity
- Chronic bronchitis
- Infections
Key indicators for considering a diagnosis of COPD?
- Dyspnea that is progressive over time, characteristically worse with exercise, persistent
- Chronic cough
- Chronic sputum production
- Recurrent lower respiratory tract infections
- History of risk factors eg tobacco smoke, vapors, fumes, gases
- Family history of COPD and/or childhood factors eg low birth weight, childhood respiratory infections
Clinical features of COPD? (6)
- Barrel chest
- Accessory muscle use
- Decreased breath sounds on ausculation
- Oxygen desaturation
- Hyperinflation on chest radiograph
- Reduced functional exercise capacity
COPD: barrel chest
Where the antero-posterior diameter of the chest wall is enlarged (like a barrel) due to hyperinflation.
COPD: accessory muscle use
Particularly the inspiratory accessory muscles, e.g. sternomastoid, pectoralis major and minor, serratus anterior, latissimus dorsi and trapezius
COPD: decreased breath sounds on ausculation due to…? What are you likely to hear if their is sputum in the airways?
Due to loss of alveoli and hyperinflation. There may be coarse crackles if sputum is present in the airways.
COPD: oxygen desaturation - when is this commonly reduced? And what is the normal range for COPD patients?
Decreased saturation during exercise and in severe cases, oxygen saturation may be also low at rest (88-92% is common)
COPD: hyperinflation on chest radiograph - key indications? 5*
- Increased radiotranslucency (i.e. dark lung fields)
- Loss of peripheral lung markings
- Rib position more horizontal
- Elongated mediastinum with narrow heart shadow
- Diaphragm intersects 11th or 12th rib posteriorly.
COPD: reduced functional exercise capacity - how is this measured?
Measured by a reduced distance walked in either the 6-minute walk test or incremental shuttle walk test compared to predicted.
In normal presentations of healthy individuals, the thorax or chest has a greater …… diameter than …… diameter. However, in a barrel chest, the individual has a wider AP diameter, making their chest look over …… (COPD)
Transverse than AP
Inflated
In COPD as the chest is filled with excess air, the diaphragm and ribs lose their normal curvature, taking on a …… appearance. The diaphragm normally has a dome like appearance, but it becomes quite flat, causing blunting of the ……. angle (where the ….. and …… meet). The lung fields also appear quite ….. and there is a loss of lung …….
Flattened
Costophrenic
Diaphragm & Ribs
Dark
Markings
What is spirometry?
A respiratory function test to diagnose COPD & identify severity of the condition. Involves maximal forced expiratory maneuvers.
The criteria for COPD diagnosis is based on….What do these values indicate?
FEV1/FVC of <0.7 (70% of predicted after bronchodilator medication)
- FVC is the amount of air that can be forcibly expired during a maximal expiration.
- FEV1 is the amount of air expired during the first second of that maximal expiration.
Classification of airflow limitation severity in COPD
- Gold 1
- Gold 2
- Gold 3
- Gold 4
Gold 1: mild = FEV 1 > 80%
Gold 2: moderate = <50-79%
Gold 3: Severe: <30-49%
Gold 4: Very severe FEV1 < 30%
**Refer to lecture notes for other measures
Management of COPD (5 stages)
- Diagnosis - symptoms, risk factors & spirometry
- Initial assessment - GOLD classification, symptoms (CAT or mMRC), exacerbation history, smoking status, co-morbidities
- Initial management
- Smoking cessation
- Vaccinations
- Activity lifestyle & exercise
- Initial pharmacotherapy
- Self management education
- Manage comorbidities - Review
- Adjust
COPD: Ventilatory constraints to exercise
- Flow limitation
- Dynamic hyperinflation
- Mechanics of breathing
- Increase work of breathing
- Abnormal gas exchange
COPD: Cardiac constraints to exercise
- Decreased cardiac output due to increased pulmonary vascular resistance and decreased venous return
COPD: skeletal muscle constraints to exercise
- Deconditioning
- Malnutrition
- Systemic inflammation
- Corticosteroid use
- Ageing
Ventilatory & Cardiac constraints cause what in COPD that reduces exercise tolerance?
Dyspnoea
Skeletal muscle & Cardiac constraints cause what in COPD that reduces exercise tolerance?
Fatigue
Supplementary oxygen in COPD
- In COPD, patients optimise their gas exchange by ….. …… leading to altered alveolar ventilation-perfusion (Va/Q) ratios
- Administering excessive oxygen overcomes this, leading to increased ….. …… to poorly ventilated alveoli, and thus increased Va/Q mismatch and increased physiological ….. …… .
- SaO2 ….-…..% in these patients - approach is associated with decreased …… in COPD patients
Hypoxic vasoconstriction
Blood flow
Dead space
88-92%
Mortality
Often concern that oxygen administration to CO2 retainers can cause type ….. respiratory failure by reducing a patient’s …. drive which causes hypoventilation (short, shallow, slow breaths = retention of further C02 can cause respiratory acidosis)
Type 2
Hypoxic
True or false: Never withhold oxygen from a seriously ill hypoxic patient due to fear of cause hypercapnic respiratory failure
True
Asthma is a ….. disease characterised by …..
Heterogeneous disease
Chronic airway inflammation
Note: It is defined by the history of respiratory symptoms that very over time and vary with intensity.
Causes of asthma
- Exposure to some viral infections in infancy
- NSAIDs
- Irritant such as smoke, air pollution & chemicals
- Viral upper respiratory infections
- Allergens eg dust, mold, etc
- Hereditary (eg parents)
- An inherited tendance to develop allergies
Asthma:
In a normal airway, smooth muscles are …… , and the airway is …… (open and clear).
In an asthmatic airway (center), the airway walls are …… and …… which reduces the diameter of the airway, but it remains open.
In an Asthmatic Airway During an Attack (Right), the smooth muscles are significantly ……, and the airway …… due to inflammation. Air becomes trapped in the ….. at the end of the airway
Relaxed & patent
Inflamed & thickened
Tightened & narrows. Alveoli.
Risk factors for asthma (> 45 yrs)
- Daily smoker
- Insufficient PA
- Obese
Clinical features of asthma
Patterns of respiratory symptoms that are characteristic of asthma:
- > 1 Symptom (wheeze, shortness of breath, cough, chest tightness)
- Symptoms worse at night or in the early morning
- Symptoms vary over time and in intensity
- Symptoms are triggered by viral infections (colds), exercise, allergen exposure, changes in weather, laughter, or irritants such as car exhaust fumes, smoke or strong smells.
Asthma – medical management
Controller (preventer) medications:
- Regular maintenance treatment to control asthma typically via inhaled ….. . E.g. Flexitide
* Decreases airway ……
* Control ……
* Reduces future risks of …… & decreases in lung function.
Corticosteroids
Inflammation
Control symptoms
Reduce future risks of exacerbations
Asthma: medical management
Reliever (rescue) medications:
Used by all patients for as-needed relief of …… …… e.g. …… / Salbutamol
* Bronchodilators
Breakthrough symptoms eg ventolin
Note: Add-on therapies (medications or non-drug therapies like breathing exercises) for patients with severe asthma: for patients with persistent symptoms and/or exacerbations despite optimized treatment with high dose controller medications and treatment of modifiable risk factors.
What is emphysema?
Emphysema is a …..-term, progressive …… lung disease of that primarily causes …… …. …… due to …..-…… of the …… & destruction of alveolar walls.
The ….. tissue involved in …… of gases is impaired or destroyed.
Long-term, obstructive, shortness of breath, over-inflation, alveoli
Lung, exchange
Pathophysiology of emphysema
- Infiltration of foreign/invading ….. (…… …… ingredients), the responding inflammatory immune cells leads to destruction of the lung’s …… barrier.
- Abnormal permanent …… of air spaces …… to the terminal bronchioles
- Destruction of ….. walls and without obvious …….
Antigens (noxious cigarrette)
Epithelial
Enlargement
Distal
Alveolar
Fibrosis
Chronic bronchitis definition
Expectoration on most days for at least 3 months in the year for at least 2 consecutive years.
Chronic bronchitis: typical sputum presentation
At baseline (without infection) sputum is generally opalescent in colour.
Chronic bronchitis pathology?
- Mucous gland hypertrophy
- Cilial dysfunction
- Chronic inflammation & narrowing of small airways
- Cellular infiltration
- Airway wall oedema
What is interstitial lung disease?
Describe a group of disorders where connective tissue (interrstitium) that surrounds the alveoli becomes scarred, impacting the compliance/stretch of the lung. This impacts the ability of alveoli to supply oxygen around the body.
Interstitial lung disease
* Majority of ILD’s ….. have a known cause.
* Some ILD’s occur due to …. exposure (dust, drugs or allergens)- i.e. silicosis, asbestosis
* Some ILDs can progress rapidly whilst others can progress ……
- Treatment can include:
- Don’t
- Environmental
- Slowly
- Supplementary 02, medication, lung transplant, pulmonary rehabilitation
Most common form of interstitial lung disease?
Idiopathic pulmonary fibrosis (IPF)
- 25-30% of all cases
- Worst prognosis (3-5 years)
Clinical features of interstitial lung disease DDLFB
- Dyspnoea on exertion
- Dry persistent cough
- Lung auscultation = “velcro” crackles throughout inspiration
- Finger clubbing occurs in some patients
- Body aches & fatigue
- Patients with neuromuscular disorders may develop a …… pulmonary disease due to the progressive ……. of their respiratory muscles.
May be caused by?
Examples?
Restrictive
Weakness
Caused by: trauma, genetic mutations, inherited, insidious
Examples: gullian barre, spinal cord injury, motor neuron disease
Musculoskeletal causes that can affect respiration?
Scoliosis/kyphosis
Ankylosing spondylitis
Flail chest
Obesity
