2. COPD

Question 1

Define COPD

Answer 1

A group of disease with symptoms of dyspnoea, cough and sputum production
FEV1/FVC<70%

Question 2

What is the definition of chronic bronchitis?

Answer 2

Productive cough for 3 months in two consecutive years where all other causes of sputum production have been ruled out

Question 3

What is the definition of emphysema?

Answer 3

Enlargement of airspaces distal to the terminal bronchus

Destruction of their walls with no obvious fibrosis

Question 4

What are the risk factors for COPD?

Answer 4

Smoking and passive smoking
Older age
Urban
Occupation
Low birth weight and chest infections in 1st year of life

Question 5

Describe the aetiology of chronic bronchitis

Answer 5

Irritants cause mucous hypersecretion
Mucous gland hypertrophy
Metaplasia of goblet cells in surface epithelium
Inflammation of CD8+, macrophages and neutrophils

Question 6

What can be seen on histology of chronic bronchitis?

Answer 6

Hypertrophy of mucous secreting glands
increased number of goblet cells in lining
Loss of ciliated epithelial cells
Inflammatory infiltrate
Squamous cell carcinoma due to dysplasia

Question 7

What complications are associated with chronic bronchitis?

Answer 7

Airflow obstruction: hypercapnia, hypoxaemia, cyanosis
Pulmonary hypertension and cardiac failure
Recurrent infections and respiratory failure

Question 8

What are the types of emphysema?

Answer 8

Centriacinar
Panacinar
Distal acinar

Question 9

What part of the lungs are most commonly affected by centriacinar emphysema?

Answer 9

Upper lobes

Question 10

What part of the lungs are most commonly affected by panacinar emphysema?

Answer 10

Lower zones

Question 11

Where is the site of distal acinar emphysema?

Answer 11

Close to pleura

Most commonly associated with pneumothorax

Question 12

Describe the pathogenesis of emphysema

Answer 12

Airflow suddenly decreases at the terminal bronchiole
Particles are dumped into nearby alveoli
Elastases in neutrophils and macrophages are turned on by irritant
Septum of alveolus is destroyed by elastase and protease activity

Question 13

What is bullous emphysema?

Answer 13

Affects distal acinus and causes bubble formation

Can rupture out into pleural cavity and cause pneumothorax

Question 14

Contrast chronic bronchitis and emphysema:

which disease has a younger patient population?

Answer 14

Chronic bronchitis: age 40-45

Emphysema: 50-75

Question 15

Contrast chronic bronchitis and emphysema:

which disease has more severe dyspnoea?

Answer 15

Emphysema

Question 16

Contrast chronic bronchitis and emphysema:

which disease results in the production of the greater amount of sputum?

Answer 16

Chronic bronchitis

Question 17

Contrast chronic bronchitis and emphysema:

which disease is associated with cor pulmonale and infections?

Answer 17

Chronic bronchitis

Question 18

Contrast chronic bronchitis and emphysema:

which disease causes a reduction in lung recoil?

Answer 18

Emphysema

Question 19

Contrast chronic bronchitis and emphysema:

which disease results in hyperinflation?

Answer 19

Emphysema

Question 20

Contrast chronic bronchitis and emphysema:

which disease is described by the phrase ‘blue bloater’?

Answer 20

Chronic bronchitis

Pink puffer= emphysema

Question 21

What staging system is used to calculate COPD severity?

Answer 21

GOLD staging system

Question 22

What are the causes of mortality in COPD?

Answer 22

Respiratory acidosis and coma
Cor pulmonale
Pneumothorax