COPD

Question 1

Which two conditions are components of COPD

Answer 1

Chronic bronchitis and emphysema

Question 2

What brings about an inflammatory response in COPD

Answer 2

Exposure to noxious substances such as cigarette smoke, cannabis, resin, dust exposure.

Question 3

When does the changes to the lungs of COPD become irreversible

Answer 3

In the early stages, symptoms and pathophysiology is reversible. However, in the long term, irreversible changes occur such as the breakdown of the respiratory tissues with particular damage to small airways and alveoli.

Question 4

What is produced in excess in COPD

Answer 4

Mucus.

Question 5

Why are patients with COPD vulnerable to recurrent infection

Answer 5

Due to poor ventilation and a degree of immunocompromise.

Question 6

What non-pulmonary complications can arise from COPD

Answer 6

• Hypoxia leads to pulmonary vasoconstriction to try and match ventilation and perfusion. This causes pulmonary hypertension which puts back pressure on the heart and can cause right sided heart failure (cor pulmonale) with ankle oedema.
• Peripheral oedema
• Weight loss
• Muscle wasting
• Osteoporosis (partly due to poor nutrition and partly due to long term corticosteroid use).

Question 7

What is chronic bronchitis

Answer 7

Inflammation in the airways and excess mucus production. This leads to obstruction of air flow.

Question 8

What is emphysema

Answer 8

The breakdown of small airways and alveoli due to inflammation and proteolytic enzymes from white cells.

Question 9

What becomes an issue with the lack of tissue in the lung caused by emphysema

Answer 9

There is less elastic recoil in the small airways which then tend to collapse. Air trapping is the result.

Question 10

What are three risk factors for COPD

Answer 10

• Smoking
• Occupation
• Recurrent infection.

Question 11

What are the signs of COPD

Answer 11

• Hypoxia
• Cyanosis
• Tachypnoea
• Pursed lip breathing to try and maximise pressure in the airways during the expiratory phase and prevent the small airways from collapsing.

Question 12

What are the three pillars that make up the management of COPD

Answer 12

• Lifestyle changes
• Pharmacological management
• Occasionally surgical management.

Question 13

What is the most important lifestyle change that can be made by people with COPD

Answer 13

Smoking cessation.

Question 14

What four things can be used in pharmacological management of COPD

Answer 14

• Oxygen
• Bronchodilators
• Corticosteroids
• Antibiotics

Question 15

What are three types of bronchodilators used in COPD management

Answer 15

• Beta 2 agonists
• Theophyllines
• Anti-muscarinic drugs

Question 16

What is an example of a corticosteroid that can be taken orally and is used to treat acute exacerbations of COPD

Answer 16

Prednisolone.

Question 17

Why are antibiotics used in people with COPD

Answer 17

Because these people are more prone to recurrent infection which exacerbate the COPD symptoms. COPD patients should be managed with antibiotics at an early stage.

Question 18

What do beta two agonists do in the lungs

Answer 18

There are beta 2 receptors present in the lungs. These are normally bound to by neurotransmitters such as adrenaline which is part of the sympathetic nervous system, to bring about bronchodilation. This increases the lumen of the bronchi and increases airflow. Beta 2 agonists mimic this action to bring about bronchodilation.

Question 19

What is the normal action of muscarinic receptors in the lungs

Answer 19

The smooth muscle surrounding the airways is innervated by cholinergic parasympathetic nerves for which acetylcholine is the neurotransmitter. When acetylcholine binds to muscarinic receptors, this brings about bronchoconstriction and mucus secretion.

Question 20

What do anti-muscarinic drugs do

Answer 20

They inhibit the action of acetylcholine at muscarinic receptors in the smooth muscle of the airways to bring about bronchodilatation and inhibition of mucus secretion.

Question 21

Which two surgical responses can be used in the management of COPD

Answer 21

• Bullectomy - large air spaces

- Transplant - only offered in very rare cases.

Question 22

What is typically present on an x-ray for COPD

Answer 22

• Overinflated lungs with more than 6 ribs visible anteriorly
• Diaphragms low and flat
• The heart to some extend is narrow and stretched.