Week 103 Wheeze 1 (COPD) Flashcards
What is COPD?
A chronic, slowly progressive disorder characterised by fixed or partially reversible airway obstruction and associated with an abnormal inflammatory response of the lungs and noxious particles or gases.
Name 3 clinical features of severe COPD
Agitated (Low po2) or sleepy (high po2)
Smoker; lip pursing; plethoric; hyperinflated chest; bounding pulse
wheeze; oedema; cyanosis
warm hands/metabolic flap; sob
Frequent infective exacerbations; purulent sputum
Name 3 causes of COPD
- ) Smoking
- ) Exposure to noxious particles
- ) Genetic - Alpha -1 antitrypsin deficiency
Is FEV1/FVC reduced or heightened in copd patients? Why?
Reduced
Airway obstruction prevents rapid expulsion.
Bronchodilators act upon ______ receptors. They are receptor ____, affecting ______. They cause the dilatation of ______.
Beta 2 receptors
Agonists
Adrenaline
Bronchioles
Which drugs INHIBITS bronchoconstriction?
Tiatropium and ipratropium. These act upon m1 and m3 receptors.
These are muscurinic receptor antagonists, otherwise known as LAMA’s and SAMA’s.
Wgat is meant by FEv1?
Forced expiratory volume (1)
The volume of air expired forcefully in one second.
What should FEV1/FVS be, as a %?
Approx 70%.
Describe chronic bronchitis.
An inflammatory process in the walls of the bronchiles, with excess mucus production and sputum from hypertrophic glands.
Diagnosis of bronchitis defined as?
Cough productive of purulent sputum for 3 months of the year for two consecutive years.
What is emphysema?
Destruction of lung tissue distal to the terminal bornchioles.
Cells release proteases (elastase, matrix metalloproteases) which breakdown elastin and collagen. These overwhelm the bodies natural anti-protease, causing destruction of alveolar walls.
Name on short acting B2 agonist.
Salbutamol
Terbutaline
Name 1 long acting beta-2 agonist?
Salmeterol
Formeterol
If a patient presents with COPD like symptoms, with diurnal variation and no smoking history, would your differential diagnosis change?
Likely to be asthma.
A patient presents to SAU with an acute exacerbation of COPD. What investigations would you consider?
ABG CXR ECG FBC7 Renal profile Sputum for bacteriology/ blood cultures
What breath sound would you hear in croup?
Stridor.
If breath sounds are absent, what likely pathologies do you suspect?
Pleural effusion
pneumothorax
What are the associated changes associated with chronic bronchitis?
loss of ciliated cells
squamous metaplasia
How does small airways disease differ from emphysema?
Fibrosis
The reduced blood flow associated with emphysema causes what?
Pulmonary hypertension.
What condition associated with COPd is described as a symptom with pathological appearances?
Chronic bronchitis
What condition associated with COPD is described as a structural abnormality?
emphysema
Name a long acting beta 2 agonist (LABA)
Salmeterol
Blocking of muscurinic 2 receptors (m2) causes _______.
< Acth release
What is ipratropium?
Short acting muscurinic receptor antagonist.
What’s the first line treatment for a patient with COPD?
Short acting beta 2 agonist.
Which neurotransmitter is involved with bronchodilation?
Adrenaline
What drug treatment can be used to break down mucus in the lung?
Carbocysteine
What are the long term effects of corticosteroids?
osteoporosis
hypertension
diabetes m
What is levosimendan?
A calcium sensitising drug, used to improve muscle function in patients with respiratory muscle weakness.
What effect does a negative intrapleural pressure cause?
Inward recoil of lungs
outward recoil of chest wall
What parts of the airway make up the conducting zone?
trachea
bronchi
bronchioles
terminal bronchioles
What parts of the airway make up the transitional and respiratory zones?
respiratory bronchioles
alveolar ducts
alveolar sacs
oxygen partial pressure in air is ____ mmhg
150
Oxygen partial pressure in lung and blood is _____ mmhg
100
Oxygen partial pressure in tissues is ____mmhg.
30
What is known as the anatomical dead space?
Conducting airways
What is total volume of air that enters the airway?
500 ml
