COPD lecture notes

Flashcards for vocabulary review of COPD lecture notes.

COPD

A preventable disease and a leading cause of morbidity and mortality worldwide.

COPD

Heterogenous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, sputum production and/or exacerbation) due to abnormalities of airways and/or alveoli that cause persistent, often progressive, airflow obstruction.

Chronic bronchitis

Defined as cough and expectoration most days for 3 or more successive months for at least 2 successive years in absence of any other conditions that may explain it.

Emphysema

Abnormal permanent enlargement of alveoli with destruction of alveolar walls without obvious fibrosis.

Chronic Bronchitis (Blue Bloater)

Characterized by cough, overweight, cyanosis, elevated hemoglobin, peripheral edema, and rattling noises while breathing.

Emphysema (Pink Puffer)

Characterized by labored breathing, thin body build, barrel chest, shortness of breath, use of accessory muscles to breathe, and frequent respiratory infections.

Smoking

The most important environmental risk factor for COPD.

Biomass exposure

Burning wood, animal dung, crop residues, and coal in open fires can lead to high levels of household air pollution and is a risk factor for COPD.

Dusty occupations

Occupations such as coal and gold mining, farming, grain handling, and cement and cotton industries are risk factors for COPD.

SERPINA1 gene mutation

Leads to hereditary deficiency of alpha 1-antitrypsin (AATD).

Mucous gland hypertrophy

Main pathological feature of chronic bronchitis.

Centrilobular emphysema

Affects the lung apices and peripheral areas of the lungs and is associated with smoking.

Panacinar emphysema

Affects the lower lung zones and is associated with alpha 1 antitrypsin deficiency.

Para septal emphysema

Affects the peripheral parts of the lungs, occurs in smokers, and predisposes to bullae formation.

Protease-antiprotease imbalance

A mechanism of COPD where emphysema is due to an imbalance between proteases (digest elastin) and antiproteases (protect against this attack).

Alpha 1-antitrypsin

The major antiprotease in the lung; its deficiency results in emphysema.

Chronic cough

Often the first symptom of COPD, initially present only on waking up, later occurring throughout the day.

Dyspnea

A cardinal symptom of COPD, chronic and progressive over time.

Sputum production

A cardinal symptom of COPD; patients commonly raise small quantities of tenacious sputum with coughing.

Orthopnea

May be present in typical patient with established COPD.

Tachypnea

May be present in typical patient with established COPD.

Pursed lip breathing

Expiratory feature seen in COPD patients.

Barrel-shaped chest

Occurs in COPD due to widening of the xiphisternal angle.

Hoover's sign

Costal margin retraction on inspiration due to the horizontal position of the diaphragm, pulling in the lower ribs during inspiration.

Hyperresonance

Percussion finding in COPD due to encroachment on hepatic and cardiac dullness.

Diminished vesicular breath sounds

Auscultation finding in COPD.

Expiratory wheezes

Common auscultation finding in COPD.

Crackles at lung bases

May be heard in chronic bronchitis patients with COPD.

Cor pulmonale

Right-sided heart failure due to pulmonary hypertension caused by lung destruction in COPD.

Cyanosis

May be present at rest or with mild exertion in severe COPD cases.

Oedema of ankles

May be present due to cor pulmonale in severe COPD cases.

Clubbing

Not a feature of COPD and suggests malignancy, bronchiectasis, or other lung diseases.

Severity of airflow obstruction

One of the five fundamental aspects to assess in COPD to guide therapy.

Nature and magnitude of current symptoms

One of the five fundamental aspects to assess in COPD to guide therapy.

Previous history of exacerbations

One of the five fundamental aspects to assess in COPD to guide therapy.

Blood eosinophil count

One of the five fundamental aspects to assess in COPD to guide therapy.

Presence and type of other diseases (Multimorbidity)

One of the five fundamental aspects to assess in COPD to guide therapy.

GOLD 1

Mild COPD; FEV1 > 80% predicted.

GOLD 2

Moderate COPD; FEV1 between 80-50% predicted.

GOLD 3

Severe COPD; FEV1 between 50-30% predicted.

GOLD 4

Very Severe COPD; FEV1 < 30%.

mMRC dyspnea scale

A dyspnea questionnaire used to assess symptoms.

COPD Assessment Test (CAT)

A test used to assess symptoms, with scores ranging from 0-40.

Exacerbation of COPD

An event characterized by dyspnea and/or cough and sputum that worsens over < 14 days.

Combined assessment of COPD

Involves assessment of airflow obstruction, symptoms/risk of exacerbations.

Chest X-ray in COPD

Not diagnostic but may suggest hyperinflated chest.

Radiological features of emphysema

Include low flattened diaphragm, hyperlucency of the lung, narrowed cardiac shadow, peripheral vascular attenuation, and increased retrosternal airspace.

Computed tomography (CT)

Used for screening for lung cancer, detecting differential diagnoses, and before lung volume reduction.

Pulmonary function testing

Gold standard to diagnose COPD.

Arterial blood gases in early COPD

Show hypoxemia and normal PaCO2.

Arterial blood gases in late COPD

Show hypoxemia and hypercapnea.

Serum alpha 1-antitrypsin level

Estimation is indicated in any young patient less than 45 years with emphysema or in patient with strong family history

Type A COPD (Pink Puffer)

Characterized by intense dyspnoea with purse-lip breathing, absent cyanosis, thin body build, and near-normal blood gas values.

Type B COPD (Blue Bloater)

Characterized by relatively mild dyspnoea, common cyanosis, often obese body build, and abnormal blood gases.

Asthma

A differential diagnosis of COPD.

Congestive heart failure

A differential diagnosis of COPD.

Bronchiectasis

A differential diagnosis of COPD.

Tuberculosis

A differential diagnosis of COPD.

Smoking history

Positive in COPD, usually negative in Asthma.

Course of the disease

Progressive in COPD, intermittent in Asthma.

Cough

Early morning in COPD, night or morning in Asthma.

Sputum

Occasionally purulent in COPD, not purulent in Asthma.

Medical interventions for COPD

Include bronchodilators, corticosteroids, and methylxanthines.

Bronchodilator therapy

Corner stone in COPD treatment.

Inhaled B2 Agonists

relax bronchial muscles.

Inhaled Anticholinergics

Decrease mucus gland secretions and are subcorner stone of treatment

Salbutamol

SABA.

Terbutaline

SABA.

Salmeterol

LABA.

Formoterol

LABA.

Tiotropium bromide

Long acting anticholinergic.

Aclidinium

Long acting anticholinergic.

Corticosteroids

Shorten recovery time and improve lung function in COPD.

ICS

Indicated in patients on LAMA + LABA therapy with high eosinophil count (>300 cell/ul).

Supplemental oxygen

Should be titrated to improve the patient's hypoxemia with a target saturation of 88-92% in acute exacerbation of COPD.

PaO2 < 55 mmHg

Indication for long-term oxygen therapy.

TYPE 2 respiratory failure

Provide 02 AND remove CO2

PH <7.35

Indication for Non-invasive intermittent positive pressure ventilation (NIPPV).

Roflumilast

Approved for Patients with COPD with an FEV1 < 50% predicted>.

Lung volume reduction surgery

Interventional care in COPD.

Definition of ACUTE EXACERBATION OF COPD

An event characterized by dyspnea and/or cough and sputum that worsens over < 14 days.

Most frequent cause of ACUTE EXACERBATION OF COPD

pneumonia, heart failure and pulmonary embolism

antibiotics

Indicated when Have three cardinal symptoms: increase in dyspnea, sputum volume, and sputum purulence.

Oral steroids days

▪ 5-7 days.

ICU admission indication

sever dyspnea that responds inadequately to initial emergency

ICU admission indication

changes in mental status (confusion, lethargy, coma)

ARDS

acute respiratory failure

ARDS

acute respiratory failure

COPD

chronic respiratory disease characterized by airflow limitation.

Emphysema

destruction of alveolar walls.

Chronic bronchitis

inflammation of the bronchi.

Tobacco smoke

major risk factor for COPD.

Dyspnea

shortness of breath.

Cough

common symptom of COPD.

Sputum production

another common symptom of COPD.

Airflow limitation

characteristic feature of COPD.

FEV1

forced expiratory volume in one second.

FVC

forced vital capacity.

FEV1/FVC ratio

used to diagnose COPD.

Bronchodilators

medications that open up the airways.