COPD

Question 1

What is COPD characterized by?

Answer 1

Airflow obstruction that is usually progressive and not fully reversible, doesn’t change markedly over months

Question 2

What are the 2 diseases encompassed in COPD?

Answer 2

1. Chronic bronchitis
2. Emphysema
   (can have either or both)

Question 3

What characterizes Emphysema?

Answer 3

Destruction of the terminal bronchioles and distal airspaces leads to loss of alveolar SA

Question 4

What occurs as a result of the destruction of terminal bronchioles and distal airpspaces in emphysema?

Answer 4

Destruction of tissues…

a) removes scaffolding support of small airways which makes them collapse leading to obstruction
b) increases compliance: reducing lung recoil leading to hyperinflation

Question 5

Is emphysema an obstructive or restrictive disease and why?

Answer 5

Obstructive due to the loss of tissue scaffolding and subsequent collapsing of smaller airways

Question 6

What are bullae and when do they form?

Answer 6

Permanent air filled spaces within lung parenchyma with a thin/poorly defined wall formed during emphysema

Question 7

What are the 2 types of emphysema?

Answer 7

1. Centrilobular: primarily upper lobes, occurs with loss of resp. bronchioles in proximal portion of acinus with sparing of distal alveoli
2. Panlobular: Involves all lung fields, especially the bases

Question 8

What characterizes chronic bronchitis?

Answer 8

Inflammation in larger airways leads to chronic mucus hyper-secretion, this causes re-modelling and narrowing of airways

Question 9

What are 3 symptoms of chronic bronchitis?

Answer 9

1. Chronic productive cough
2. Frequent infections (damage to mucociliary escalator)
3. Progressive breathlessness and increasing frequent exacerbations

Question 10

What is the main cause of COPD, and what are 3 other causes?

Answer 10

1. Smoking
2. Alpha-1-antitrypsin deficiency: no inhibitor of trypsin means neutrophil elastase is constantly activated causing persistent lung tissue damage
3. Occupational exposure
4. pollution

Question 11

Explain the MRC Dyspnoea score

Answer 11

Grade of breathlessness

1: not troubled except during hard exercise
2. Short of breath when hurrying or walking up slight hill
3. walks slower than contemporaries on level ground due to breathlessness
4. Stops for breath after walking 100m or so
5. Too breathless to leave house, dress, etc

Question 12

What are 5 signs of COPD?

Answer 12

1. Pursed lips: increases the pressure in airways to force them open
2. Tachypnoea
3. Use of accessory muscles
4. Hyperinflation: air trapping
5. May have wheeze or quiet breath sounds

Question 13

As the disease advances what 3 things are likely to occur?

Answer 13

1. CO2 retention
2. Cyanosis
3. R heart failure

Question 14

What is the predicted percentage of FEV1 in mild, moderate and severe airflow obstruction?

Answer 14

Mild: 50-80% predicted
Moderate: 30-49% predicted
Severe: <30% predicted

Question 15

How would you diagnose COPD?

Answer 15

Combination of suggestive symptoms and signs with at least mild airflow obstruction (spirometry)

Question 16

Compare the differences between COPD and asthma on the basis of these factors:

Smoker
Symptoms <65
Chronic productive cough
Breathlessness
Nighttime waking with breathlessness or wheeze
Diurnal or day-day variability of symptoms

Answer 16

Smokers: COPD - nearly all, asthma - possible

Symptoms <65: COPD - rare, asthma often

Chronic productive cough: COPD - common, asthma - uncommon

Breathlessness: COPD - persistent/agressive, asthma - variable

Nighttime waking with breathlessness or wheeze: COPD - common, asthma - uncommon

Diurnal or day-day variability of symptoms: COPD - uncommon, asthma - common

Question 17

What investigations could you do for COPD?

Answer 17

1. Chest-x ray; not diagnostic
2. High resolution CT scan: can assess emphysema destruction
3. Arterial blood gases: assess resp failure
4. alpha1 anti-trypsin for younger patients

Question 18

Compare Emphysema and chronic bronchitis on the basis of these factors;

Area destroyed
V/Q
Level of hypoxia
Other symptom:

Answer 18

Area destroyed: Emphysema parenchyma, chronic bronchitis-small airway inflammation

VQ: emphysema; matched, chronic bronchitis; mis-matched

Level of Hypoxia: Emphysema; mild hypoxia, chronic bronchitis; severe hypoxia and hypercarbia

Other symptom: emphysema; cachexia, chronic bronchitis; pulmonary hypertension and cor pulmonale

Question 19

List 6 factors part of the MDT approach - COPD care bundle

Answer 19

1. smoking cessation support
2. pulmonary rehab
3. bronchodilators
4. anti-muscarinics
5. steroids
6. mucolytics

Question 20

Name the pros and cons of one bronchodilator that can be used

Answer 20

Salbutamol: B2 agonist
Bronchodilator but may activate B2 receptors in the heart causing adverse side effects; tachycardia, palpitations, hypokalemia

Question 21

Name the pros and cons of one anti-muscarinic that can be used

Answer 21

Impratropium: reduces bronchoconstriction and mucus secretion

Adverse effects: dry mouth and cough, sore throat, pharyngitis, upper resp tract infections

+Other ANTI parasympathetic responses; urinary difficulty, constipation, AF, etc.

Question 22

Name an example of a mucolytic

Answer 22

Carbocysteine (clears mucus)

Question 23

What are the pros and cons of corticosteroids?

Answer 23

Pros: reduce inflammation

Cons: thin skin, bruising, osteoporosis, diabetes (increase insulin resistance), weight gain, mental disturbance

Question 24

What is the key message around drug therapy for COPD?

Answer 24

Can improve symptoms but not cure

Question 25

How would you manage the acute exacerbations for COPD?

Answer 25

1. O2 saturation with O2 therapy is aimed to be 88-92% 2. Use nebulised bronchodilators 3. Antibiotics if suspected infection 4. Ventilation if arterial blood gases don't improve 5. Oral or IV steroids

Question 26

What are the criteria for offering a patient long-term oxygen therapy?

Answer 26

1. If pO2 is consistently blow 7.3 kPa 2. Patient's must be non-smokers 3. patient's must be retaining high levels of CO2

Question 27

What are 2 therapies that can be offered if the COPD is very advanced

Answer 27

1. Lung volume reduction; reduces hyperinflation | 2. Long-term oxygen therapy

Question 28

What are 3 things patients can do for self-management

Answer 28

Get help, recognize if their symptoms worsen, rescue pack-antibiotic/oral steroids

Question 29

What are some benefits of pulmonary rehab?

Answer 29

1. Nutritional counselling 2. Exercise training - increased exercise tolerance 3. Increased knowledge on self-management and lung condition 4. Increased independence in daily function 5. breathing strategies 6. Psychological counselling and/or group support