21.22.23. COPD

Question 1

What is COPD?

Answer 1

COPD is characterized by persistent respiratory symptoms and airflow limitation that is due to airway / alveolar abnormalities usually caused by significant exposure to noxious particles or gases.

Question 2

What are the most common respiratory symptoms of COPD?

Answer 2

The most common respiratory symptoms of COPD are dyspnea, cough, and/or sputum production.

Question 3

What are the risk factors for COPD?

Answer 3

• tobacco smoking (main risk),
• environmental exposures such as biomass fuel exposure and air pollution,
• host factors such as genetic abnormalities, abnormal lung development, and accelerated aging.

Question 4

What is the pathology of COPD?

Answer 4

The pathology of COPD includes chronic inflammation and structural changes (tissue destruction).

Question 5

What is the pathogenesis of COPD?

Answer 5

• oxidative stress leading to protease-antiprotease imbalance,
• that causes inflammatory cells (neutrophils, lymphocytes) to produce inflammatory mediators,
• leading to peribronchiolar and interstitial fibrosis.

Question 6

What is the difference between centriacinar and panacinar emphysema?

Answer 6

Centriacinar emphysema affects respiratory bronchioles and is associated with smoking, while panacinar emphysema affects the entire acinus and is associated with alpha1-antitrypsin deficiency.

Question 7

What is paraseptal emphysema?

Answer 7

Paraseptal emphysema affects distal airspaces and is associated with scarring from previous infections.

Question 8

What is the diagnostic test required to make a diagnosis of COPD?

Answer 8

Spirometry.

Question 9

What is the criteria for confirming the presence of persistent airflow limitation in COPD, using spirometry?

Answer 9

The presence of a post-bronchodilator FEV1/FVC < 0.7.

Question 10

What are some clinical symptoms of COPD? (aka think of what you can notice in phys exam)

Answer 10

• Barrel chest,
• peripheral edema,
• hyper-resonant lungs on percussion,
• decreased breath sounds on auscultation.

Question 11

What are some other symptoms of COPD?(less specific)

Answer 11

• Fatigue,
• weight loss,
• anorexia,
• syncope,
• rib fractures,
• ankle swelling,
• depression
• anxiety.

Question 12

What is the pathophysiology of COPD?

Answer 12

• Airflow limitation and gas trapping,
• gas exchange abnormalities,
• mucus hypersecretion
• secondary pulmonary hypertension

Question 13

What is the key factor in the diagnosis of COPD?

Answer 13

The presence of dyspnea, chronic cough or sputum production, and/or a history of exposure to risk factors for the disease.

Question 14

What should be the key finding in spirometry after bronchodilation inhalation?

Answer 14

FEV 1/FVC <70%.

Question 15

What are the two methods for symptoms assessment in COPD?

Answer 15

• COPD assessment test (CAT),
• medical research council (mMRC) questionnaire - dyspnea scale

Question 16

What is the pathophysiology of emphysema?

Answer 16

• Chronic inflammation leads to an increase in proteases.
• Nicotine use (or other noxious stimuli) inactivates protease inhibitors (especially alpha1-antitrypsin),
• it all leads to an imbalance of protease and antiprotease, which increases elastase activity.
• This results in the loss of elastic tissue and lung parenchyma via destruction of alveolar walls.

Question 17

What are the clinical features of pink puffers in emphysema?

Answer 17

• dyspnea accompanied by hyperventilation, which leads to adequate blood exchange, proper oxygenation, and a pink appearance.
• barrel chest,
• sit forward in a hunched-over position.
• Weight loss and pursed-lip breathing are common
• they have a normal FVC, but decreased FEV1, resulting in a reduced FEV1/FVC ratio.

Question 18

What are the clinical features of blue bloaters in emphysema?

Answer 18

• Blue bloaters may have coughing or wheezing as their first sign.
• They have less prominent dyspnea and respiratory drive, leading to CO2 retention, hypoxia, and cyanosis, resulting in a blue appearance.
• They have peripheral edema
• They have an increased FVC, but decreased FEV1, resulting in a normal or increased FEV1/FVC ratio.

Question 19

What is the ABCD assessment tool used for?

Answer 19

The ABCD assessment tool is used to classify COPD patients based on their symptoms and exacerbation history to determine the appropriate treatment plan.

Question 20

What is the first step in prevention and maintenance therapy for COPD?

Answer 20

Smoking cessation is the first step in prevention and maintenance therapy for COPD.

Question 21

How does pulmonary rehabilitation help in COPD?

Answer 21

Pulmonary rehabilitation improves symptoms, quality of life, and physical and emotional participation in everyday activities for COPD patients.

Question 22

When is long term 02 therapy recommended? When is it not?

Answer 22

• In patients with severe resting chronic hypoxemia.
• It is not recommended for patients with stable COPD and exercise-induced desaturation

Question 23

What is the benefit of long-term non-invasive ventilation in patients with severe chronic hypercapnia and a history of hospitalization for acute respiratory failure?

Answer 23

It may decrease mortality and prevent re-hospitalization.

Question 24

What is the goal of palliative approaches in advanced COPD?

Answer 24

They are effective in controlling symptoms.

Question 25

What is an exacerbation of COPD?

Answer 25

It is an acute worsening of respiratory symptoms that results in additional therapy.

Question 26

What is the most common cause of exacerbations of COPD?

Answer 26

Respiratory tract infections such as influenza, strep, and COVID.

Question 27

What is the goal for treatment of COPD?

Answer 27

To minimize the negative impact of the current exacerbation and prevent subsequent events.

Question 28

What is the recommended initial bronchodilator for treating an acute exacerbation of COPD?

Answer 28

• If mild : short-acting inhaled beta-2 agonists (SABA), with or without short acting anticholinergics
• Can also use antibiotics and / or oral corticosteroids

Question 29

What are the benefits of systemic corticosteroids for COPD patients during an exacerbation?

Answer 29

They can improve lung function (FEV1), oxygenation, and shorten recovery time and hospitalization duration.

Question 30

What is the recommended duration of systemic corticosteroid therapy for COPD patients during an exacerbation?

Answer 30

Not more than 5-7 days.

Question 31

What is the benefit of antibiotics for COPD patients during an exacerbation?

Answer 31

They can shorten recovery time, reduce the risk of early relapse, treatment failure, and hospitalization duration.

Question 32

What are the two types of leukotriene modifiers?

Answer 32

• 5-LO inhibitors (Zileuton)
• CysLT1 antagonists (Montelukast).

Question 33

What are the two types of long-acting bronchodilators?

Answer 33

Long-acting beta-2 agonists (LABA) and Theophyllines (per os).

Question 34

What are the main classes of medications used in COPD treatment?

Answer 34

Bronchodilators and corticosteroids.

Question 35

How do bronchodilators improve COPD symptoms?

Answer 35

They relax the muscles around the airways, making it easier to breathe.

Question 36

What is the difference between short-acting and long-acting bronchodilators?

Answer 36

Short-acting bronchodilators provide quick relief of symptoms, while long-acting bronchodilators provide sustained relief over a longer period.

Question 37

What is the mechanism of action of corticosteroids in COPD treatment?

Answer 37

They reduce inflammation in the airways.

Question 38

What is the role of oxygen therapy in COPD management?

Answer 38

It can improve survival and quality of life in patients with severe COPD and low oxygen levels.