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Respiratory System > Week 7 - COPD and Lung Cancer > Flashcards

Week 7 - COPD and Lung Cancer Flashcards

1
Q

Define chronic bronchitis.

A

Defined as the presence of cough and excessive mucus production on most days for at least 3 consecutive months for 2 successive years

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2
Q

Define emphysema.

A

Defined as the permanent destructive enlargement of air spaces distal to the terminal bronchiole

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3
Q

State the pathological features of chronic bronchitis which result in expiratory airflow limitation in COPD.

A
  1. Increased number of goblet cells in epithelium - increased mucus production
  2. Reduced cilia (loss of ciliated epithelium) - ciliary dysfunction prevents mucus from being swept up
  3. Submucous gland hyperplasia - thickening of the bronchial wall and increased mucus production

Increased bronchial wall thickness and excess mucus - reduced calibre of the lumen and airways obstruction

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4
Q

State the pathological features of emphysema which result in expiratory airflow limitation in COPD.

A
  1. Progressive destruction of alveolar walls and reduction in capillary bed
  2. Loss of radial traction of lung tissue on bronchioles - airways narrowing
  3. Enlarged airways and airspaces (bullae)
  4. Reduced elastic recoil
  5. Reduced alveolar surface for gas exchange
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5
Q

What lung function tests can be used to investigate COPD?

A
  1. Spirometry - tidal volume, vital capacity, measurement of FVC, FEV1, ratio of FEV1/FVC, flow-volume loops
  2. Measurement of lung volumes - helium dilution or by plethysmography
  3. Measurement of diffusion - CO transfer factor
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6
Q

What are the changes in a flow-volume loop for an individual with COPD?

A
  1. Low PEFR
  2. Scooped-out flow volume curve
  3. Normal inspiratory airflow
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7
Q

Why is the diffusion capacity (as measured by TLCO) reduced in patients with COPD?

A

Destruction of alveolar walls and reduction of capillary bed in emphysema reduce overall surface area available for gas exchange

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8
Q

What are the typical radiological findings in COPD?

A
  1. Hyperinflation of the lungs - more than 6 ribs seen anteriorly
  2. Flattening of the diaphragm
  3. Heart may appear elongated and thin
  4. Ribs may appear to be more horizontal
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9
Q

Outline the features of chronic type 2 respiratory failure.

A
  1. CO2 retention: bounding pulse, warm hands, flapping tremors
  2. Pulmonary hypertension and right heart failure: cor pulmonale
  3. Compensatory changes for hypoxia including polycythaemia
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10
Q

Outline the type of respiratory failure seen in COPD patients.

A

Initially Type 1: ventilation-perfusion mismatch due to poor ventilation of parts of the lung
Type 2 later: hypoventilation - late stages, when FEV1 < 1 litre, this occurs gradually and so patients show features of chronic type 2 RF

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11
Q

What are the possible consequences of using oxygen in patients with chronic hypercapnia?

A
  1. Risk of CO2 retention - O2 in blood rises but CO2 also rises
  2. Can cause acidosis and organ dysfunction, and when severe, coma
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12
Q

What are the mechanisms by which administering high dose oxygen to patients with chronic hypercapnia can cause harm?

A
  1. Hypoxic drive reduced: hypoxia acting via peripheral chemoreceptors stimulates breathing, central chemoreceptors adapted to higher carbon dioxide levels
  2. Worsening V/Q mismatch: when oxygen is given, hypoxic vasoconstriction is reduced, and poorly ventilated areas of the lung receive more blood causing worsening V/Q mismatch
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13
Q

How should oxygen be administered to COPD patients?

A

Low dose titrated oxygen - constantly monitor arterial blood gas to ensure hypercapnia is not worsening

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14
Q

What structure in the CNS coordinates coughing?

A

Medulla oblongata

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15
Q

What is coughing initiated by?

A

Irritation of cough receptors in upper airway

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16
Q

Outline the steps involved in coughing.

A
  1. Glottis closes
  2. Strong contraction of the expiratory muscles - abdominal muscles and internal intercostals - builds up intrapulmonary pressure
  3. Glottis suddenly opens –> explosive discharge of air
17
Q

What are important aspects to inquire about while taking an asthma history?

A
  1. Allergies
  2. Family history
  3. Maternal smoking (for children)
  4. Social
  5. House: pets, carpet
18
Q

What does eczema look like?

A
  1. Red, scaly patches of skin
  2. Usually itchy
  3. Often confined to flexures of limbs
19
Q

Why is eczema relevant to asthma?

A

It is part of generalised atopy

20
Q

What drugs are commonly used for long-term prophylaxis of asthma?

A

Inhaled corticosteroids

21
Q

State 2 topical B2 agonists that can be used in asthma.

A
  1. Salbutamol

2. Terbutaline

22
Q

State how B2 agonists can be administered for children.

A
  1. Usually via an inhaler device - young children have difficulty coordinating inspiration with activation of the device
  2. Therefore, a spacer device is used where the child simply breathes in and out through the device or using a face mask
23
Q

How would you confirm suspicion that someone has asthma?

A
  1. Examination
  2. Lung function tests with response to bronchodilators
  3. Daily peak flow recordings to demonstrate variability, especially during working days
  4. Bronchial challenge test
24
Q

Outline what the bronchial challenge test demonstrates.

A
  • This test demonstrates hyper-reactive airways
  • Involves giving a cholinergic drug (inhaled methacholine or histamine)
  • Stimulation of muscarinic receptors
  • Contraction of smooth muscle in the airway
  • May induce acute asthma and may have to be reversed with a bronchodilator
25
Q

Which substance in paint can contribute to asthma?

A

Isocyanate

26
Q

What is the mechanism by which some chemicals cause asthma?

A

Irritants

27
Q

List 6 occupations in which asthma can occur and the chemicals involved.

A 
Bakers - yeast 
Plastic workers - isocyanate 
Healthcare workers - latex in gloves
Solderers - Collophony
Lab animal workers - rat urine
Wood workers - pliatic acid (constituent of wood)
28
Q

What are the harmful effects of long-term oral steroids in adults?

A
  1. Adrenal suppression
  2. Skin thinning, bruising, osteoporosis
  3. Oral candidiasis
  4. Central obesity, glucose intolerance, increased appetite
  5. Hypertension
  6. Depression/mania

(Long - term oral steroids in COPD are associated with increased mortality independent of the severity of disease)

Respiratory System (3 decks)

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