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Flashcards in COPD Deck (62)
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1

What is the definition of COPD

Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases.

2

What is COPD predominantly caused by

- smoking
- occupational exposures

3

What cause exacerbations

- rapid sustained worsening of symptoms beyond normal day to day variations

4

What is the definition of chronic bronchitis

the presence of chronic productive cough and sputum for at least 3 months in each of two successive years

5

What is emphysema

- emphysema in anatomic terms is enlarged alveolar spaces and loss of alveolar walls

6

What is COPD characterised by

- COPD is characterised by airflow obstruction that is not fully reversible.
• The airflow obstruction does not change markedly over several months and is usually progressive in the long term.

7

How do you work out pack years

Pack Years
• Pack Years = Number of Packs/day X Years smoked
• One pack = 20 Cigarettes (was lower and therefore cheaper)

8

What can cause COPD

- smoking
- coal
- cotton
- cement
- cadmium
- (Corn) grain
- infections than lead to progressive Alpha 1 antitrypsin deficiency
- alpha 1 antitrypsin deficiency

9

What is COPD an umbrella term for

- Covers the irreversible aspect of chronic bronchitis, emphysema and asthma

10

Describe the pathophysiology of chronic bronchitis

- Hypertrophy of mucus secreting glands
- increase in mucous production and sputum expectoration
- infiltration of bronchial walls with inflammatory cells which leads to airway narrowing

11

Describe the pathophysiology of emphysema

- loss of elastic recoil - airflow limitation and air trapping
- bulla formation

12

describe what cells are involved in asthma

- CD4+ T lymphocytes
- eosinophils
- macrophages
- mast cells

13

Describe what cells are in COPD

- CD8+ T lymphocytes
- macrophages
- neutrophils

14

who does COPD tend to present in

- over 35
- smoker/ex smoker

15

name the symptoms of COPD

- exertional breathlessness
- chronic cough
- regular sputum production
- frequent winter bronchitis
- wheeze

16

What are the investigations and diagnosis tools used in COPD

Consider in patients who are over 35 years of age who are smokers or ex-smokers
Investigations
- Post-bronchodilator spirometry to demonstrate airflow obstruction
- CXR - hyperinflation, bullae, flat hemidiaphragm, excludes lung cancer
- FBC – exclude secondary polycythaemia
- BMI calculation

17

What are the signs of COPD

- tachypnoea
- use of accessory muscles of respiration
- hyperinflation
- ↓expansion
- resonant or hyperresonant percussion note
- quiet breath sounds (eg over bullae)
- wheeze
- cyanosis
- cor pulmonale.

18

describe the difference MRC dyspnea scales

mMRC grade 0
- I only get breathless with strenuous exercise

mMRC grade 1
- I get short of breath when hurrying on the level or walking up a slight hill

mMRC grade 2
- I walk slower than people of the same age on the level because of breathlessness or I have to stop for breath when walking on my own pace on the level

mMRC grade 3
- I stop for breath after walking about 100m or after a few minutes on the level

mMRC grade 4
- I am too breathless to leave the house or I am breathless when dressing or undressing

19

What are the clinical signs of COPD

- wheeze
- tachypnea
- prolonged expiration
- use of accessory muscles
- pursed lip breathing
- hyper-inflated lungs
- cyanosis
- heart failure

20

What is hoover's sign

- refer to the paradoxical inspiratory retraction of the rib cage and lower intercostal interspaces

21

What is Dahl's sign

Dahl's sign, a clinical sign in which areas of thickened and darkened skin seen on the lower thighs and/or elbows, is seen in patients with severe chronic respiratory disorders such as chronic obstructive pulmonary disease (COPD), interstitial lung disease, congestive heart failure (CHF)

22

Describe how the ABCD assessment tool works

A - mMRC of 0-1, and CAT <10, 0 or 1 moderate or severe exacerbation (not leading to hospital admission)

B - mMRC > 2, CAT > 10, 0 or 1 moderate or severe exacerbation (not leading to hospital admission)

C - mMRC of 0-1, and CAT <10, greater than 2 moderate or serve exacerbation or greater than 1 leading to hospital admission

D mMRC > 2, CAT > 10, greater than 2 moderate or serve exacerbation or greater than 1 leading to hospital admission

23

What are the goals of COPD management

- relieve symptoms
- prevent disease progression
- improve exercise tolerance
- improve health status
- prevent and treat complications
- prevent and treat exacerbations
- reduce mortality

24

describe the post bronchodilator grade

Post bronchodilator grade based on FEV1 number
Gold 1 – mild
- Greater than or equal to 80%
Gold 2 - moderate
- 50-79%
Gold 3 – severe
- 30-49%
Gold 4 – very severe
- Less than 30%

25

Name some smoking cessation drugs

- Varenicline (champix)
- nicotine replacement therapy
- bupropion (zyban)

26

How does varenicline (champix) work

- selective nicotine receptor partial agonist

27

How do you do nicotine replacement therapy

- use as a replacement therapy in abrupt cessation or to slowly reduce

Various form
- patches
- gum, lozenges, oro-nasal spray
- inhalation

28

What does the treatment for COPD do

- decrease symptoms
- decrease exacerbations
- slow decline in FEV1
- not life prolonging

29

what can reduce serious illness in COPD patients

influenza vaccines
- pneumococcal polysaccharide vaccine is recommended for COPD patients 65 years and older and for COPD patients younger than age 65 with an FEV1 < 40% predicted

30

What are the drugs that are used in COPD

- Short acting bronchodilators
- anti-cholinergic
- long acting bronchodilators: LABA, Anti-cholinergics
- Inhaled corticosteroids
- Phosphodiesterase inhibitors: Theophyllines, Roflumilast