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Flashcards in COPD Deck (23)
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1
Q

What is the biggest risk factor for COPD?

A

Smoking

2
Q

What evidence is there for corticosteroids in COPD?

A

NEJM 2014 - there was no difference in exacerbation rates between those who had corticosteroids withdrawn and those who remained on LABA and anticholinergic alone

3
Q

What is the “treatment ladder” for treatment of COPD?

A

SABA, LABA, anticholinergic, corticosteroid

4
Q

What non-pharmacological management options are there for COPD?

A

Pulmonary rehab, Pneumococcal and influenza vaccine, smoking cessation, oxygen (severe)

5
Q

When should you consider alpha 1 antitrypsin as a possible cause of COPD?

A
COPD/empysema under age 45
absent risk factors
empysema of lower lungs
unexplained liver disease
asthma with persistent air flow obstruction after treatment
C-ANCA vasculitis
necrotising panniculitis
family history
6
Q

Lung function test findings in COPD?

A

FEV1/FVC less then 0.7
Increased RV, FRC and TLC due to air trapping
Normal or decreased DLCO due to destruction of gas exchange units

7
Q

What is the main cell involved in the pathogenesis of COPD?

A

Macrophage

8
Q

What is centriacinar empysema associated with?

A

Smoking

Occurs in upper lobes and superior lower lobes

9
Q

What is panacinar empysema associated with?

A

Alpha 1 antitrypsin

Occurs predominately in lower lobes

10
Q

What are the GOLD stages for COPD?

A
1 = mild = FEV1 greater then 80% predicted but ratio less than 0.7
2 = moderate = FEV1 between 50-80% predicted
3 = severe = FEV1 30-50% predicted
4 = very severe = FEV1 less then 30% predicted
11
Q

What are the only 3 interventions shown to improve mortality in COPD?

A

Smoking cessation
Oxygen therapy for hypoxia
Lung volume reduction surgery
Some evidence that corticosteroids may have a mortality benefit - trend only, not significant

12
Q

What is the ladder of treatment in COPD?

A
PRN bronchodilators (B agonists, anticholinergics)
Add regular long acting B agonists
Add inhaled corticosteroids if symptoms not controlled or greater then 2 exacerbations per year
Triple therapy in severe disease - combination ICS + LABA + long acting anti-cholinergic + PRN SABA
13
Q

What is the drug with the best evidence for smoking cessation?

A

Varencicline

Followed by NRT then bupropion

14
Q

What is the concern with inhaled corticosteroid use in COPD?

A

Increases risk of pneumonia by x2 compared with salmeterol alone

15
Q

Who is a good candidate for lung volume reduction surgery?

A

those with upper lobe predominant disease and poor 6 minute walk test

16
Q

What makes up the BODE scoring system for COPD?

A

BMI
Airflow obstruction (FEV1)
Dysnoea
Excercise capacity (6MWT)

17
Q

12 month mortality after an exacerbation of COPD?

A

42%

18
Q

What is the genetic mutation in A1AT def?

A

mutation in SERPINA1 gene - codes for alpha-1-antitrypsin protein

19
Q

What causes the liver disease in A1AT?

A

Mutated alpha-1 antitrypsin protein cannot leave the liver - accumulates and causes liver failure

20
Q

What causes the lung disease in A1AT?

A

Low serum and alveolar levels of A1AT (as it is all stuck in the liver and cant escape). A1AT usually functions to protect the alveloli against proteases released from inflammatory cells - in its absence get progressive destruction of alveloar and empysema

21
Q

What are the main alleles causing disease in A1AT?

A

M normal phenotype
Z markedly reduced levels
S some reduced levels

Homozygote ZZ causes most disease
Carriers MS or MZ have only 35% action of A1AT but do not mainfest disease

22
Q

What is the inheritance of A1AT def?

A

autosomal co-dominant

- over 120 affected alleles

23
Q

What is the role for chronic antibotics in COPD?

A

1 year of macrolides showed a decrease in hospital admissions with exacerbations but increased rates of deafness and antibiotic resistance