COPD

Question 1

Pathophysiology

Answer 1

combination of chronic bronchitis, emphysema and potentially asthma

CB

• chronic irritation and inflammation of the epithelium
• results in mucus gland hypertrophy and hypersecretion
• results in destruction of ciliated epithelium which is replaced with non-ciliated cells
• results in overall impairment to MCC
• bronchial wall hypertrophy - thickening of the airways and increased propensity for bronchospasm

Emphysema

• exposure to toxins = destruction of elastin = lost elastic recoil
• reduced area for gas exchange
• small airway walls become floppy and collapse

Question 2

Clinical Implications

Answer 2

airflow limitation 
impaired airway clearance 
impaired gas exchange 
dyspnoea 
reduced exericise tolerance 
musculoskeletal dysfunction 
respiratory muscle dysfunction 
abnormal breathing pattern

Question 3

Clinical Features

Answer 3

Hyperinflation - barrel chest, CXR changes 
Reduced BS throughout the lungs with ausc
Abnormal breathing pattern 
- accessory muscle use 
- upper chest breathing 
- pursed lip breathing 
- prolonged expiration 
chronic cough 
oxygen desaturation on pulse oximetry 
reduced functional exercise capacity 
reduced general muscle strength 
adopt positions for breathlessness for extended periods of time 
issues with incontinence

Question 4

Medical Management

Answer 4

aimed at slowing deterioration and optimising QOL 
smoking cessation 
pharmacology - vaccinations, puffers 
surgical interventions 
oxygen therapy 
ventilatory support

Question 5

COPD-X Plan

Answer 5

C - confirm diagnosis and assess severity
O - optimise function
P - prevent deterioration
D - develop support network and self-management
X - manage exacerbations

Question 6

Physio Management

Answer 6

spirometry assessment 
time treatment to be post inhaled therapies 
exacerbation management - sputum, breathlessness etc. 
pulmonary rehab 
dyspnoea management 
airway clearance 
continence screening 
education