COPD

Question 1

What is the definition of COPD?

Answer 1

Chronic obstructive pulmonary disease
Poorly reversible airflow limitation that is usually progressive
FEV1/FVC <0.7
FEV < 80%

Question 2

What is the pathology of COPD?

Answer 2

• Associated with persistent inflammatory response of the lungs
• Chronic bronchitis
• Airway narrowing = airflow limitation
• Hypertrophy and hyperplasia of mucus secreting glands
• Bronchial wall inflammation
• Mucosal oedema
• Epithelial cell layer may ulcerate
• Squamous epithelium may replace columnar epithelium when ulcers heal = squamous metaplasia
• ‘Blue bloaters’ = bronchitis>emphysema
• Emphysema
• Dilatation and destruction of the lung tissue distil to the terminal bronchioles
• Loss of elastic coil
• Expiratory air flow limitation and air trapping
• ‘Pink puffer’ = emphysema>bronchitis
• Smoking
• Causes mucous gland hypertrophy in larger airways
• ↑ in neutrophils, macrophages and lymphocytes in the walls
• α1 – antitypsin deficiency is inactivated by cigarette smoke

Question 3

What are the risk factors/aetiology of COPD?

Answer 3

• Smoking
• Exposure to pollutants e.g. mining, building, chemical industries
• Outdoor air pollutions
• Inhalation of smoke e.g. biomass fuels
• Alpha-1 antitrypsin deficiency – early onset

Question 4

What are the signs/symptoms of COPD?

Answer 4

•	Productive cough – inc. purulent sputum 
•	Wheeze
•	Breathlessness at rest
•	Prolonged expiration
•	Poor chest expansion
•	Lung hyperinflation – loss of cardiac and liver dullness
•	Cyanosis 
•	Oedema
•	CO2 retention
•	warm peripheries
•	bounding pulse
•	flapping tremor
•	confusion
Thin with loss of muscle mass
Pursed lip breathing
Increased work of breathing:
Leaning forward
Accessory muscles of respiration
Tracheal tug
Nasal flare
Paradoxical abdominal movement
Indrawing of intercostal muscles

Question 5

What investigation are conduced for suspected COPD?

Answer 5

• Lung function tests
• Peak flow
• Spirometry
• CXR
• CT
• FBC – haem and packed cell volume may be high due to persistent hypoaemia
• ABG
• α1 – antitypsin serum levels
• EGC – for cor pulmonale

Question 6

What are the surgical treatments for COPD?

Answer 6

• Bullectomy – for patients with large emphysematous bullae

* Lung volume reduction surgery - severe

Question 7

What are the pharmacological treatments for COPD?

Answer 7

• Bronchodialators – e.g. tiotropium bromide
• Corticosteroids e.g. prednisolone
• Abx – rescue pack for acute exacerbations
• Pneumococcal vaccine
• Mucolytics
• Diuretics – for oedema

Question 8

What are the non pharmacological treatments for COPD?

Answer 8

• Smoking cessation
• Oxygen
• Exercise training
• High calorie diet