6. COPD

Question 1

What does COPD include?

Answer 1

Emphysema

Chronic bronchitis

Question 2

What happens in emphysema?

Answer 2

Alveolar wall damage

• larger alveoli
• cant support bronchioles -> collapse

Question 3

What is the most common cause of emphysema?

Answer 3

Smoking

Question 4

Is emphysema reversible or irreversible?

Answer 4

Irreversible

Question 5

Other than smoking, what can cause emphysema?

Answer 5

Alpha1-antitrypsin deficiency - means elastase can break down elastin in lungs, leading to alveolar wall damage

Question 6

What is chronic bronchitis?

Answer 6

Chronic bronchiole inflammation
Increase in mucus
Inflammation causes permanent damage and narrows airway
Chronic productive cough

Question 7

What is the main risk factor of chronic bronchitis?

Answer 7

Smoking

Question 8

Is chronic bronchitis reversible or irreversible?

Answer 8

Irreversible

Question 9

What are the risk factors for COPD?

Answer 9

Smoking
Men>women
Older people
Childhood respiratory diseases
Genetics e.g. A1AT deficiency
Exposure

Question 10

What are the symptoms of COPD?

Answer 10

Breathlessness
Wheeze
Productive cough

Question 11

How is COPD investigated?

Answer 11

Spirometry - low FEV:FVC, poor bronchodilator reversibility

CXR - hyperinflation

Question 12

How do you assess the severity of COPD?

Answer 12

Low FEV

MRC dyspnoea scale

Question 13

What is the management of COPD?

Answer 13

Prevention - stop smoking
Pharmacology - inhalers (SABA,LABA, antimuscarinics, steroids)
Non-pharmacological - vaccines, chest physio

Question 14

What happens in hypoxic drive?

Answer 14

Increased pCO2
Therefore pH decreases because of central chemoreceptors
Causes hyperventilation, but pCO2 does not reduce
Kidneys then increase HCO3- which corrects pH - compensated
Low O2 does not stimulate peripheral chemoreceptors, so RR remains low

Question 15

If a patient is in hypoxic drive, what do you give them?

Answer 15

O2 but only to keep sats at 88-92%

Question 16

What can cause acute exacerbation of COPD?

Answer 16

Infection - viral or bacterial

Question 17

What do patents present with in acute exacerbation?

Answer 17

Increased dyspnoea, cough, production/type of sputum, wheeze

• using accessory muscles (tripodding)
• pursed lip breathing
• cyanosis

Question 18

How do you rule out differentials in acute exacerbation?

Answer 18

CXR
ABG
FBC, CRP, U&E’s
Cultures - blood and sputum

Question 19

What is the management for acute exacerbation?

Answer 19

SABA and SAMA (ipratropium) - nebuliser
Steroids
Antibiotics
O2 if <88-92%

Question 20

What are the long term complications of COPD?

Answer 20

1. Chronic hypoxia -> pulmonary vasoconstriction -> widespread vasoconstriction -> pulmonary hypertension -> cor pulmonale (right sided heart failure)
2. Chronic respiratory failure
3. Chronic hypoxia -> polycythaemia