COPD

Question 1

What are three components/changes seen in COPD?

Answer 1

1. Airway inflammation
2. Mucocilliary dysfunction
3. Tissue damage

Question 2

Single biggest cause of COPD?

Answer 2

Smoking

Question 3

Summarise the pathogenesis of COPD? (4steps)

Answer 3

1. Toxic particle, cigarette smoke
2. Alveolar macrophages release neutrophil chemotactic factors ( IL8)
3. Macrophages + neutrophils release proteases
4. Proteases destroy lung parenchyma and cause mucus hyper secretion.

Question 4

What are the two end results of the COPD process?

Answer 4

1. Emphysema

2. Chronic bronchitis

Question 5

What is emphysema?

Answer 5

Alveolar wall destruction

Question 6

What is chronic bronchitis?

Answer 6

Mucus hyper-secretion

Question 7

What causes mucus hyper secretion?

Answer 7

Neutrophil elastase released in the process of COPD damages cilia.
Mucociliary clearance reduced= hyper-secretion

Question 8

What are COPD patients prone to getting?

Answer 8

Infection

Question 9

Most common pathogen associated with COPD?

Answer 9

H. influenzae

Question 10

What is the cause of emphysema?

Answer 10

Imbalance between protease and anti-proteases

Question 11

Signs/symptoms of COPD?

Answer 11

1. Chronic
2. Smoking
3. Non atopic
4. Daily productive cough
5. Progressive breathlessness

Signs
6. Frequent infective exacerbations
7. chronic bronchitis- wheezing
emphysema- reduced breath sounds

Question 12

What can be the progressive disease cascade in COPD if not treated?

Answer 12

• Fixed airflow obstruction
• Impaired gas exchange
• Low pO2, High pCO2
• Pulmonary hypertension
• Right ventricular hypertrophy/failure (cor pulmonale)
• Death

Question 13

What is cor pulmonale?

Answer 13

Pulmonary hypertension leading to right sided heart failure

Question 14

What is the key pathological feature in asthma copd overlap syndrome?

Answer 14

COPD caused by eosinophilic inflammation not neutrophilic.

Question 15

What is the most important Non pharmacological intervention?

Answer 15

STOP smoking

Improves lung function- better FEV1/FEVR

Question 16

What are two indicators of high risk COPD? (Hint- infection, fev)

Answer 16

1. Two or more infective Exacerbations in a year

2. FEV1<50 %

Question 17

What are the treatment steps for COPD?

Answer 17

1. SABA/SAMA - eg salbutamol, ipratropium
2. LABA/LAMA- formoterol, tiotropium
3. ICS + LABA OR LABA + LAMA- Budesonide & tiotropium or formoterol & tiotropium

LABA/LAMA combo shown to be more effective

4. LABA + LAMA + ICS

Question 18

Treatment for Acute COPD?

Answer 18

Nebulised high dose salbutamol
Ipratropium
Prednisolone