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Respiratory > Week 6 - COPD > Flashcards

Week 6 - COPD Flashcards

1
Q

What is the main cause of COPD?

A

-Smoking

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2
Q

What two conditions play a role in COPD?

A
  • Emphysema

- Chronic Bronchitis

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3
Q

What is emphysema?

A

-Pathological process which results in the destruction of elastin of the alveoli in the lung which reduces SA and impairs gas exchange

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4
Q

What is a bullae?

A

-Large redundant airspaces in the lung

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5
Q

Why does emphysema cause airflow obstruction?

A

-Desctruction of supporting tissue around small airways results in these airways closing sooner during expiration as the intrathoracic pressure rises

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6
Q

Why does emphysema result in hyperinflation?

A
  • Loss of elastic recoil of lungs -> cannot resist tendancy of ribcage to pull outwards
  • Airway resistance increases quicker than normal and air becomes trapped inside
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7
Q

What is chronic bronchitis?

A

-Chronic mucus hypersecretion caused by inflammation in the large airways leading to proliferation of mucus cells

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8
Q

What is most often the cause of chronic bronchitis?

A

-Smoking

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9
Q

What are the characteristic symptoms of chronic bronchitis?

A
  • Chronic productive cough

- Frequent respiratory infection

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10
Q

Why does chronic bronchitis cause airway obstruction?

A
  • Remodelling and narrowing of airways due to inflammation

- Mucus hypersecretion

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11
Q

Besides smoking, what else can lead to COPD?

A
  • a1-antitrypsin deficiency
  • Occupational exposure (coal dust)
  • pollution
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12
Q

What are the presenting symptoms of COPD?

A

-Productive cough and SoB which is progressive

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13
Q

Describe the MRC Dyspnoea score

A

1) strenuous exercise
2) Up a slight hill
3) Slow on level ground
4) Has to stop on level ground
5) Cant leave the house

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14
Q

What are characteristic signs of COPD?

A
  • Purse lip breathing
  • Tachypnoea
  • Using acessory muscles
  • Hyperinflation (barrel chest)
  • Wheesze or silent breathing
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15
Q

Why do people with COPD exhibit purse lip breathing?

A

-Increased the pressure within the airways causing a delay in closure

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16
Q

How does hyperinflation lead to breathlessness in COPD?

A

-Diaphragm and resp muscles have to work harder to ventilate the lungs

17
Q

What are some advanced signs of COPD?

A
  • Cyanosis
  • CO2 retention/flap
  • Cor Pulmonale
  • Oedema
18
Q

What is essential for diagnosis of COPD?

A
  • Good history

- Measurement of airflow obstruction using spirometry

19
Q

What are the spirometry results in a person with COPD?

A
  • Reduction in FEV1 due to airway obstruction and collapse on expiration and a reduced FEV1:FVC ratio
  • Mild 50-80% predicted
  • Moderate 30-49% predicted
  • Severe less than 30
20
Q

State 3 differences between COPD and Asthma

A
  • COPD not fully reversible; asthma is
  • COPD has a productive cough; asthma is dry
  • COPD occurs in elderly patients; asthma presents in young
21
Q

What other investigations besides spirometry can be ordered in COPD?

A
  • CXR to exclude other diagnoses
  • HRCT shows degree of alveolar destruction
  • ABG to assess resp failure
  • a1-antitrypsin in young paitents
22
Q

What type of resp failure is COPD?

A

-Type 2

23
Q

Describe a care bundle for COPD

A
  • Smoking cessation
  • Pulmonary rehab
  • Bronchodilators and antimuscurinics
  • Steroids
24
Q

How does salbutamol help in COPD? Describe the molecular pathway

A

-B2 agonist -> activation of b2 receptor -> activation and dissociation of Gas -> stimulates adenyl cyclase ->Increased cAMP-> activated PKA -> phosphorylation of MLCK -> smooth muscle relaxation

25
Q

Describe the adverse effects of salbutamol

A
  • Tachycardia
  • Tremor
  • Anxiety
26
Q

Why are anticholinergics used in COPD?

A
  • M3 receptors in lungs cause bronchoconstriction

- Antagonising these receptors reduces bronchoconstrictors

27
Q

What is theophylline(methylxanthines)?

A

-Bronchodilator which inhibits phosphodiesterases -> increased cAMP

28
Q

Name some side effects of long term steroid use

A
  • Thin skin
  • Bruising
  • Cataracts
  • Osteoporosis
29
Q

What is the function of mucolytics?

A

-Reduces thickness of sputum

30
Q

Why are steroids used in COPD?

A

-To reduce inflammatory pathways

31
Q

What is pulmonary rehabilitation?

A
  • Many patients with COPD avoid exercise because of breathlessness -> muscles weaken -> increased breathlessness
  • Leads to a vicious cycle
  • Pulmonary rehab breaks this cycle via a programme exercise and nutrition
32
Q

Who is suitable for long term oxygen therapy?

A

-Non-smokers with a pO2 below 7.3kPa (or 8 with cor pulmonale) without CO2 retention

33
Q

How many hours a day does oxygen need to be admitted?

A

-16 hours

34
Q

What are the surgical options for COPD?

A
  • Lung volume reduction to reduce hyperinflation

- Transplant in young patients

35
Q

Why do you have to be careful when administering O2 to COPD patients?

A
  • Disruption of hypoxic vasoconstriction worsens V/Q mismatch
  • Hypoxia now drives respiration as central chemoreceptors will have reset to high pCO2 -> correcting hypoxia may decrease drive
36
Q

How do you manage an acute exacerbation whom not responding to initial treatment and is acidotic?

A
  • Non invasive ventilation

- Invasive ventilation

37
Q

What are some contraindications to non invasive ventilation?

A
  • Pneumothorax
  • Impaired GCS
  • Vomiting
38
Q

What is Chronic Obstructive Pulmonary Disease?

A

-Condition with airflow obstruction which is usually progressive, not fully reversible and does not change markedly over several months

Respiratory (17 decks)

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