How is Chronic Obstructive Pulmonary Disease (COPD) defined regarding its symptoms and cause?
It is characterised by persistent respiratory symptoms and airflow limitation caused by airway and/or alveolar abnormalities from exposure to noxious particles or gases.
What clinical criteria define chronic bronchitis?
The presence of a chronic productive cough and sputum for at least 3 months in each of two successive years.
Pathologically, what defines emphysema?
An abnormal, permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by wall destruction without obvious fibrosis.
What genetic deficiency is a known risk factor for COPD?
α-1 antitrypsin deficiency.
List three environmental or occupational risk factors for COPD.
Occupational dust and chemicals, indoor smoke from cooking fuels (e.g. wood, coal), and smoke from crackers.
COPD is considered an umbrella term covering the irreversible aspects of which three conditions?
Chronic bronchitis, emphysema, and asthma.
What is the formula for calculating ‘Pack Years’ for a smoker?
Number of packs per day×Years smoked.
Calculate the pack-year history for a person who smoked 10 cigarettes (0.5 packs) a day for 40 years.
20 pack years.
In the pathophysiology of chronic bronchitis, what change in the mucus-secreting glands leads to increased sputum production?
Hypertrophy of the glands.
What specific airway change in chronic bronchitis is caused by the infiltration of bronchial walls with inflammatory cells?
Airway narrowing.
How does the loss of elastic recoil in emphysema affect lung function?
It leads to airflow limitation and air trapping.
What is the primary cause of ‘bulla’ formation in emphysema?
The destruction of the alveoli.
Which symptom of COPD is specifically associated with physical activity?
Exertional breathlessness.
What clinical sign involving the lips is often observed in COPD patients to assist breathing?
Pursed-lip breathing.
Why do COPD patients often use accessory muscles during respiration?
To assist with the increased work of breathing caused by airflow obstruction and hyper-inflated lungs.
At what age should a clinician begin to suspect COPD in a patient presenting with risk factors and symptoms?
Over 35 years.
Which diagnostic test is required to confirm a diagnosis of COPD?
Post-bronchodilator spirometry.
What specific post-bronchodilator spirometry ratio confirms persistent airflow obstruction?
FEV 1/FVC < 0.7
In the differential diagnosis, how does the onset of COPD typically differ from asthma?
COPD onset is usually in mid-life, whereas asthma often begins early in life (childhood).
Contrast the reversibility of airflow limitation between COPD and asthma.
COPD airflow limitation is largely irreversible, while asthma is largely reversible.
How does the variability of symptoms differ between COPD and asthma?
COPD symptoms are slowly progressive, while asthma symptoms vary significantly from day to day.
On a chest x-ray, what change in the diaphragm angle (lateral film) indicates lung hyperinflation?
An increase from the normal 45∘ to > 90∘
