COPD

Question 1

what are the 3 main types of COPD

Answer 1

1. Chronic bronchitis
2. Emphysema
3. A1AT deficiency

Question 2

define COPD

Answer 2

progressively worsening, irreversible airflow limitation

Question 3

risk factors for COPD

Answer 3

• cigarettes
• air pollution
• genetics
• male
• older age

Question 4

pathophysiology of chronic bronchitis

Answer 4

1. hypertrophy and hyperplasia of mucous glands to protect vs cigarette smoke
2. chronic inflammatory cells infiltrate bronchi = luminal narrowing
3. leads to mucus hypersecretion, ciliary dysfunction, narrowed lumen
4. therefore increased infection risk and airway trapping

Question 5

pathophysiology of emphysema

Answer 5

1. destruction of elastin layer of resp bronchioles/alv ducts/alv sacs (keeps them open) = leads to distal air trapping
2. can form BULLAE
3. two main types:
   - centriacinar (resp bronchioles involved only - SMOKERS
   - panacinar (A1AT deficiency!)

Question 6

what is the role of elastin

Answer 6

keeps walls open during expiration
- therefore decreased elastin means air trapped distal to blockage

Question 7

what are bullae

Answer 7

large air sacs

Question 8

pathophysiology of A1AT deficiency

Answer 8

autosomal co-dominant inheritance

1. A1 antitrypsin degrades NE which protects excess damage to elastin layer in lungs
2. A1 antitrypsin deficiency means more NE
3. leads to panacinar emphysema and liver issues

Question 9

who to suspect A1AT deficiency in

Answer 9

suspect in male px <40 with little/ no smoking Hx

Question 10

symptoms of COPD

Answer 10

• CHRONIC PRODUCTIVE COUGH with purulent sputum (NO DIURNAL VARIATION, constant, for 2+ years),
• dyspnoea
• often get chest infections.

Question 11

signs of COPD

Answer 11

classic barrel chest

Question 12

what does blue boater refer to

Answer 12

chronic bronchitis
more overweight, cyanotic

Question 13

what does pink puffer refer to

Answer 13

ephysema
thinner px, barrel chest, muscle wasting, pursed lip breathing

Question 14

how to diagnose COPD

Answer 14

Pulmonary function tests

Question 15

how to carry out pulmonary function tests

Answer 15

1. do Fraction expired nitrous oxide (feNO) = raised non specific in lung damage
2. Then do Spirometry = FEV1:FVC less than 0.7 (obstruction)
3. Then do bronchodilator reversibility test = less than 12% increase in FEV1 (IRREVERSIBLE)

Question 16

other tests for COPD

Answer 16

• ECG
• chest X ray
• ABG

Question 17

what does chest X ray for COPD show

Answer 17

• flattened diaphragm
• bullae formation
• enlarged lungs

Question 18

what is the single most important thing for COPD treatment

Answer 18

STOP SMOKING

Question 19

what is the at-home pharmacalogical algorithm for COPD treatment

Answer 19

1. SABA (salbutamol) (PRN)
2. SABA + LABA (salmeterol) + LAMA (tiotropium bromide)
3. SABA + LABA + LAMA + ICS (e.g. prednisolone)

Question 20

COPD treatment for acute exacerbations

Answer 20

1. O2 sats maintained to 88-92% as opposed to 92-96% in normal lungs.
2. SABA, SAMA, ICS, Abx if IECOPD

Question 21

how to treat very severe COPD

Answer 21

LONG TERM OXYGEN THERAPY (LTOT)

88% O2 sats, given 15+h daily for 3 weeks
→ MUST BE NON SMOKING WHEN ON LTOT

Question 22

complications of COPD

Answer 22

IECOPD, cor pulmonale (RHS failure due to pul htn)