COPD

Question 1

What does COPD stand for?

Answer 1

Chronic Obstructive Pulmonary Disease

Question 2

The term COPD is given to what?

Answer 2

Emphysema and chronic bronchitis of the lungs resulting in irreversible restricted airflow to the lungs

Question 3

What is COPD characterised by?

Answer 3

Poorly reversible airway obstruction
An abnormal inflammatory response to long-term exposure to toxic gases and particles

Question 4

The abnormal inflammatory response represents the response from what due to what?

Answer 4

The innate and adaptive immune response to long-term exposure to noxious particles and gases, particularly cigarette smoke

Question 5

What do all cigarette smokers have?

Answer 5

Some inflammation in their lungs

Question 6

Cigarette smokers who develop COPD have what?

Answer 6

An enhanced or abnormal response to inhaling toxic agents

Question 7

The amplified response to inhaling toxic agents may result in what?

Answer 7

Mucous hypersecretion (chronic bronchitis)
Tissue destruction (emphysema)
Disruption of normal repair and defence mechanisms causing small airway inflammation and fibrosis (bronchiolitis)

Question 8

The pathological changes in COPD result in what?

Answer 8

Increased resistance to airflow in the small conducting airways
Increased compliance of the lungs
Air trapping
Progressive airflow obstruction

Question 9

Which structural changes can lead to airflow limitation?

Answer 9

Airway narrowing
Loss of elastic recoil
Air trapping

Question 10

How does airway narrowing cause airflow limitation?

Answer 10

Caused by inflammation that results in mucus hypersecretion, oedema of the airway and bronchospasm

Question 11

How does loss of elastic recoil cause airflow limitation?

Answer 11

Due to destruction of the alveolar air sac, reduces the lungs’ ability to recoil and concurrently reducing the surface area of the lung for gaseous exchange

Question 12

How does air trapping cause airflow limitation?

Answer 12

Due to airway narrowing and mucous plugging, gas can get trapped in the alveoli after exhaling. This decreases the amount of air exchange happening in the lung

Question 13

What structural changes can lead to inflammation?

Answer 13

Mucus hypersecretion
Tissue destruction

Question 14

How does mucus hypersecretion lead to inflammation?

Answer 14

The goblet bronchial epithelial cells overproduce and accumulate mucus in the airways which can lead to chronic bronchitis

Question 15

How does tissue destruction lead to inflammation?

Answer 15

Hyper-infiltration of neutrophils and macrophages into the airways results in a release of inflammatory mediators. These mediators result in the destruction of the alveolar air sacs which can lead to emphysema

Question 16

Inflammation in the small airway leads to what?

Answer 16

Disruption of the body’s repair and defence mechanisms leading to bronchiolitis.

Question 17

Which rare genetic disease can cause COPD?

Answer 17

Alpha-1 antitrypsin deficiency

Question 18

What is Alpha-1 antitrypsin deficiency?

Answer 18

An inherited disorder that may cause lung disease or liver disease

Question 19

Those with alpha-1 antitrypsin deficiency normally develop the first signs and symptoms of lung disease between which ages?

Answer 19

25-50

Question 20

What early symptoms would someone with alpha-1 antitrypsin deficiency present with?

Answer 20

Shortness of breath following mild activity
Reduced ability to exercise
Wheezing
Other:
Unintentional weight loss
Recurring respiratory infections
Fatigue

Question 21

Those affected by alpha-1 antitrypsin deficiency normally develop what?

Answer 21

Emphysema - a lung disease caused by damage to the alveoli in the lungs

Question 22

What are the characteristic features of emphysema?

Answer 22

Difficulty breathing
A hacking cough
Barrel-shaped chest

Question 23

What accelerates the appearance of emphysema symptoms and lung damage?

Answer 23

Smoking or exposure to tobacco smoke

Question 24

Common symptoms of COPD

Answer 24

Shortness of breath - may only happen when exercising at first and may wake up at night feeling breathless
A persistent chesty cough with phlegm that doesn’t go away
Frequent chest infections
Persistent wheezing

Question 25

What happens to COPD symptoms over time?

Answer 25

Gradually get worse and make daily activities increasingly difficult

Question 26

How does treatment help symptoms?

Answer 26

Slows progression

Question 27

When are COPD exacerbations common?

Answer 27

During the winter

Question 28

Less common symptoms of COPD

Answer 28

Weight loss Tiredness Oedema Chest pain and coughing up blood

Question 29

When do the less common symptoms of COPD happen?

Answer 29

When it reaches an advanced stage

Question 30

Which co-morbidities put patients at higher risk for COPD?

Answer 30

Lung infections, flu or pneumonia Lung cancer Heart problems Weak muscles and brittle bones Depression and anxiety

Question 31

Triggers of COPD

Answer 31

Smoking Second hand smoke Occupational exposure to dust, fumes or chemicals Indoor air pollution - biomass fuel (wood, animal dung, crop residue) or coal Early life events like poor growth in utero, prematurity, frequent or severe respiratory infections in childhood that prevent maximum lung growth

Question 32

When should COPD be suspected?

Answer 32

If a person has typical symptoms and the diagnosis confirmed by spirometry

Question 33

We suspect COPD in people aged over 35 with a risk factor (smoking, occupational or environmental exposure) and one of more of which symptoms?

Answer 33

Breathlessness (dyspnoea) - typically persistent, progressive over time and worse on exertion. Chronic/recurrent cough Regular sputum production Frequent lower respiratory tract infections Wheeze Other: Weight loss, anorexia, fatigue Waking at night with breathlessness Ankle swelling Chest pain Haemoptysis Reduced exercise tolerance

Question 34

What signs may be present on an examination?

Answer 34

May be normal Cyanosis Raised jugular venous pressure and/or peripheral oedema Cachexia Hyperinflation of the chest Use of accessory muscles and/or pursed lip breathing Wheeze and/or crackles on auscultation of chest

Question 35

Spirometry is needed for what in COPD?

Answer 35

To classify the severity Confirmation of diagnosis with a post bronchodilator FEV1/FVC <0.7 confirming persistent airflow obstruction

Question 36

What is the GOLD criteria for defining the degree of severity?

Answer 36

Stage I: Mild - FEV1 more or equal to 80% predicted Stage II: Moderate - FEV1 is more or equal to 50% but less that 80% predicted Stage III: Severe - FEV1 is more or equal to 30% but less than 50% predicted Stage IV: Very severe - FEV1 less that 30% predicted

Question 37

What lifestyle changes can help improve symptoms and prevent further development of COPD?

Answer 37

Smoking cessation + vaping Avoid second-hand smoke or smoke from indoor cooking fires Vaccination to protect against lung infections (annual flu vaccine, pneumonia vaccine, COVID-19) Active lifestyle and exercise

Question 38

Pharmacological treatment of COPD is mainly directed at what?

Answer 38

Relieving symptoms Improving quality of life

Question 39

Pharmacological treatments are administered based on what scheme?

Answer 39

The ABE scheme

Question 40

What does the ABE scheme take into account?

Answer 40

Blood eosinophils Exacerbations/hospitalisations Scoring on the modified Medical Research Council dyspnoea Questionnaire (mMRC) and the COPD Assessment Test (CAT)

Question 41

Who qualifies for group A?

Answer 41

0-1 moderate exacerbations (not leading to hospital admission) mMRC 0-1 CAT < 10

Question 42

What is given to patients in group A?

Answer 42

A bronchodilator

Question 43

Who qualifies for group B?

Answer 43

0-1 moderate exacerbations (not leading to hospital admission) mMRC more or equal to 2 CAT more of equal to 10

Question 44

What is given to patients in group B?

Answer 44

LABA + LAMA

Question 45

Who qualifies for group E?

Answer 45

2 or more moderate exacerbations or 1 or more exacerbations leading to hospitalisation mMRC 0-2 CAT less than or more than 10

Question 46

Use of what is not recommended in COPD?

Answer 46

LABA+ICS

Question 47

If there is an indication for ICS, what has been shown to be superior compared to LABA+ICS?

Answer 47

LABA+LAMA+ICS

Question 48

What should be prescribed to all patients for immediate symptoms relief?

Answer 48

Rescue short acting bronchodilators

Question 49

What other treatments may be used to treat COPD?

Answer 49

Steroid and antibiotics to treat flare-ups Oxygen for those who have had COPD for a long time or have severe COPD Pulmonary rehabilitation teaches exercises to improve breathing and ability to exercise Surgery may improve symptoms in severe COPD

Question 50

What are flare-ups often caused by?

Answer 50

A respiratory infection