COPD

Question 1

What is Chronic Obstructive Pulmonary Disease (COPD)?

Answer 1

A chronic, slowly progressive disease disorder characterised by airflow obstruction, which does not charge markedly over several months

Question 2

What is the effect of airflow obstruction on FEV₁?

Answer 2

• Reduced FEV₁
• Reduced FEV₁/FVC ratio

Question 3

What causes COPD?

Answer 3

The abnormal inflammatory response of the lung to noxious particles or gases

Question 4

Where can noxious particles or gases come from?

Answer 4

• Cigarette smoke
• Atmospheric pollutants

Question 5

What components of cigarette smoke cause lung inflammation?

Answer 5

• Biomass particles
• Particulates

Question 6

What can make the inflammation caused by cigarette smoke worse?

Answer 6

• Host factors
• Amplifying mechanisms

Question 7

How does lung inflammation from cigarette smoke cause COPD?

Answer 7

• Directly
• Oxidative stress
• Proteinases

Question 8

What attempts to protect against oxidative stress?

Answer 8

Anti-oxidants

Question 9

What attempts to protect against the action of proteinases?

Answer 9

• Anti-proteinases
• Repair mechanisms

Question 10

What is a much less common cause of emphysema?

Answer 10

Inherited deficiency of α₁-antitrypsin

Question 11

What are the symptoms of COPD?

Answer 11

• Productive cough
• Wheeze
• Breathlessness

Question 12

What does the productive cough in COPD produce?

Answer 12

White or clear sputum

Question 13

What does COPD usually follow?

Answer 13

Many years of smokers cough

Question 14

What are the signs of COPD?

Answer 14

• May be no signs
• Quiet wheezes
• Hyperventilation with prolonged expiration (in prolonged disease)
• Accessory muscles of respiration used
• Hyperinflation of the lungs

Question 15

Why is there hyperventilation with prolonged expiration in COPD?

Answer 15

Expiratory airflow limitation

Question 16

What factors are considered when assessing COPD?

Answer 16

• History
• Chest X-ray
• FEV₁
• Other lung function tests
• High resolution CT scan

Question 17

What must the history include when assessing COPD?

Answer 17

The MRC dyspnoea scale

Question 18

What would constitute grade 1 on the MRC dyspnoea scale?

Answer 18

Not troubled by breathlessness except on strenuous exercise

Question 19

What constitutes grade 2 on the MRC dyspnoea scale?

Answer 19

Short of breath when hurrying or walking up a slight hill

Question 20

What constitutes grade 3 on the MRC dyspnoea scale?

Answer 20

Walks slower than contemparies on level ground because of breathlessness, or has to stop for breath when walking at own pace

Question 21

What constitutes grade 4 on the MRC dyspnoea scale?

Answer 21

Stops for breath after walking about 100m, or after a few minutes on level ground

Question 22

What constitutes grade 5 on the MRC dyspnoea scale?

Answer 22

Too breathless to leave the house, or breathless when dressing or undressing

Question 23

What other lung function tests are carried out to assess COPD?

Answer 23

• Lung volumes
• Loop

Question 24

What is the purpose of a chest x-ray in the assessment of COPD?

Answer 24

Not really to diagnose COPD, mainly to make sure they don’t have something else, e.g. cancer

Question 25

What is the purpose of a high resolution CT scan in the assessment of COPD?

Answer 25

Detect emphysema

Question 26

What happens in spirometry?

Answer 26

The patient fills their lungs from the atmosphere, and breathes out as far and fast as possible through a **spirometer**

Question 27

What does simple spirometery allow for?

Answer 27

Measurement of many lung volumes and capacities

Question 28

What is the purpose of oxygen therapy?

Answer 28

To increase oxygen saturation and alleviate symptoms

Question 29

What is oxygen therapy a treatment for?

Answer 29

Hypoxaemia, *not breathlessness*

Question 30

What are the advantages of oxygen therapy?

Answer 30

* Long term * Portable * Intermittent

Question 31

How is COPD managed?

Answer 31

* Smoking cessation * Drug therapy * Oxygen therapy * Pulmonary rehabilitation * α₁-antitrypsin replacement * Treat co-morbid condition

Question 32

What is the single most useful measure in the management of COPD?

Answer 32

Persauding the patient to stop smoking

Question 33

What is the effect of smoking cessation in advanced disease?

Answer 33

May slow down the rate of deterioration

Question 34

What is the purpose of drug therapy in the management of COPD?

Answer 34

Used for both the short-term management of exacerbations and the long-term relief of symptoms

Question 35

What drugs are used in the treatment of COPD?

Answer 35

* Bronchodilators * Corticosteroids * Antibiotics

Question 36

What kind of drugs are bronchodilators?

Answer 36

ß₂-adrenoagonists

Question 37

What is the purpose of corticosteroids in the treatment of COPD?

Answer 37

Immunosuppressive

Question 38

What is the purpose of antibiotics in the treatment of COPD?

Answer 38

Shortens exacerbations

Question 39

When are antibiotics given in COPD?

Answer 39

As soon as sputum turns yellow or green

Question 40

What is meant by pulmonary rehabilitation?

Answer 40

Exercise training

Question 41

What does exercise training do in COPD?

Answer 41

Can modestly increase exercise capacity

Question 42

How is pulmonary rehabilitation conducted?

Answer 42

Regular training periods can be used at home

Question 43

Give two examples of exercises that may be used in pulmonary rehabilitation

Answer 43

* Walking fixed distances * Climbing stairs

Question 44

What are the co-morbidities for COPD?

Answer 44

* Cardiac * Metabolic * Nutritional * Osteoporosis * Anxiety/depression