Week 6

Question 1

What is COPD?

Answer 1

Chronic Obstructive Pulmonary Disease

• characterised by chronic and recurrent obstruction of flow in airways
• progressive and accompanied by inflammatory responses
• usually includes variations of bronchitis and emphysema with or ithout asthma

Question 2

What is the impact of COPD on indigenous populations?

Answer 2

More common - 2.5x higher

- estimated 8.8% of indig pop aged 45 and overaffected

Question 3

Where does COPD rank among causes of death?

Answer 3

#5 
4.5%

Question 4

What conditions fall under the COPD umbrella?

Answer 4

Chronic Bronchitis
+
Emphysema

Question 5

What are clinical features of COPD compared to asthma?

Answer 5

• No airway hyperreactivity
• Poor bronchodilator response
• Poor corticosteroid response

Question 6

What are clinical features of asthma compared to COPD?

Answer 6

• airway hyperreactivity
• bronchodilator response
• corticosteroid response

Question 7

What inflammatory cells are activated with COPD?

Answer 7

Neutrophils

Macrophages

Question 8

What inflammatory cells are activated with Asthma?

Answer 8

Mast Cells
Eosinophils
Macrophages

Question 9

What are the inflammatory effects of COPD?

Answer 9

• peripheral airways
• epithelial metaplasia
• parenchymal involvement
• Mucous secretion
• Fibrosis
• Oxidative stress

Question 10

What are the signs of Chronic bronchitis?

Answer 10

Blue Bloater

• overweight
• cyanotic
• elevated haemoglobin
• peripheral oedema
• rhonchi and wheezing

Question 11

What are the signs of Emphysema?

Answer 11

Pink puffer

• older and thin
• dever dyspnea
• quiet chest
• xray shows hyperinflation with flattened diaphragm

Question 12

What are the key risk factors for COPD?

Answer 12

Smoking (80-90% get that shit)
Asthmatics who smoke
Respiratory infections during childhood
Occupational exposure to dusts and chemicals
Exposure to air pollution
Age >40 when signs and symptoms begin
Genetic component

Question 13

what is the difference between chronic bronchitis and emphysema?

Answer 13

Bronchitis:
- obstructive and inflammatory process

Emphysema:

• non inflammatory:
• > dyspnea, non-reversible airway obstruction
• perfusion mismatch

Question 14

What physiological changes occur with chronic bronchitis?

Answer 14

• mucous gland enlargement
• hypersecretion of mucous
• smooth muscle hyperplasia, inflammation
• Bronchospasm, bronchial wall thickening
• mucous plugging
• Clilia lining stops working
• Loss of supporting alveolar attachments, airflow limitation
• airway wall deformation and airway lumen narrowing
• secondary polycythaemia

Question 15

What the disease progression steps for Chronic bronchitis?

Answer 15

Smoking - destroys cilia - decreased notility, increased coughing - inflammation - airway thickens - stratified squamous epithelium - goblet cell hypersecretion - increased mucous - increased sputum - accumulation of bacteria - episodic bronchitis - chronic inflammation

Question 16

What physiological changes occur with emphysema?

Answer 16

• focal destruction of terminal bronchioles and alveoli
• walls of alveoli break down due to loss of elastin
• lost elastin in replaced by collagen
• surrounding capillaries also destroyed
• loss of elastic recoil contributes more significantly to airflow limitation
• significant loss of lung volume
• formulation of bullae may lead to spontaneous pneumothorax

Question 17

What are some signs and symptoms you may find on assessment of a patient with emphysema?

Answer 17

• history
• pursed-lip breathing
• frail
• productive cough if RTI
• Barrel chest
• gasping
• exertional dyspnoea
• accessory muscle use
• quiet (wheezing)
• finger staining

Question 18

What are some signs and symptoms you may find on assessment of a patient with chronic bronchitis?

Answer 18

• History
• cyanosis
• normal/overweight
• productive cough
• use of accessory muscles
• increased infections due to cilia malfunction
• clubbing of fingers
• wheezing

Question 19

What are signs of a severe exacerbation of COPD?

Answer 19

• Use of accessory respiratory muscles
• paradoxical chest wall movement
• worsening or central cyanosis
• development of peripheral oedema
• Haemodynamic instability
• Signs of right heart failure
• ACS due to hypoxia

Question 20

What are some questions to ask when gathering the history of a patient with COPD?

Answer 20

• how long have they had the disease
• what meds are they taking
• do they have home O2 therapy, if so the flow rate and duration they need it?
• How frequent are hospital admissions? When was the last? Have there been any ICU admissions?
• What other treatments have they received on previous ED admissions?
• When did the patient start to experience symptoms leading to this episode?
• Have they been unwell lately?
• Has there been a change or limitation to daily activities
• Productive cough?
• Colour of sputum

Question 21

What is Cor Pulmonale?

Answer 21

Abnormal enlargement of the right side of the heart due to disease of the lungs or pulmonary vessles?

Question 22

How does Cor Pulmonale work?

Answer 22

Pulmonary Hypotension is the result of hypoxic pulmonary vasoconstriction, polycythemia and destruction of the pulmonary vascular bed by emphysema

• Hypoxic pulmonary vasoconstriction diverts blood away from poorly ventilated alveoli to maintain VQ balance
• pulmonary vessles adjacent to underventilated alveoli constrict increasing pulmonary vascular resistance and the work of the right heart

Question 23

What are signs of Cor Pulmonale?

Answer 23

Peripheral oedema
JVP
ECG with large P waves, RBBB and R axis deviation

Question 24

What is the indication for the use of CPAP?

Answer 24

SpO2 <90% on room air or <95% on O2.

Question 25

When do you remove CPAP?

Answer 25

• Ineffective:
• cardiac/resp arrest
• mast intolerance/pt agitation
• no improvement after 1 hour

Vital signs:

• HR <50
• SBP <90
• GCS <13
• decreasing spo2

Active risk to Pt:

• loss of airway control
• copious secretions
• active vomitting

Question 26

What is the treatment plan for COPD?

Answer 26

Salbutamol 10mg Neb
Ipratropium Bromide 500mcg Neb
Dexamethason 8mg IV/Oral

Titrate O2 to spo2 of 88-92%