COPD

Question 1

What is COPD

Answer 1

> Umbrella term for Chronic bronchitis/emphysema/chronic asthma (patients will have different combos of each)
Leads to progressive obstruction of airflow = not fully reversible
(Decline can be rapid or can plateau for months)

Question 2

Normal airways vs. COPD airways

Answer 2

> Normal airways

• mucus = produced (catch dust + bacteria)
• cilia beat to move mucus along

> COPD airways
- excess mucus = produced (thicker + stickier)
- Cilia = unable to beat + move mucus along
(Smoking will paralyse cilia)
- Dust and Bacteria remain in airways - mucus is a breeding ground for infection

Question 3

Bronchitis

Answer 3

> Chronic disease

• Bronchi become inflamed
• Greater amount of mucus is produced (difficult to clear)
• Narrowing of airways
• Breathing difficulty (post cough - bronchospasm may occur due to inflamed airways + reduce air into lungs further - wheeze can be heard)

> Symptoms

• malaise
• fatigue
• cough doesn’t clear mucus

Question 4

Emphysema

Answer 4

> Alveoli become inflamed - lose natural elasticity
Over expand - losing ability to fill up + contract properly
Reduced surface area for gas exchange as air fills up sacs (some will rupture + become one sac)
Overinflation - trapped air can’t get out (breathing becomes increasingly difficult)

Question 5

Asthma

Answer 5

> Usually acute (not included in COPD)

• airways are more sensitive
• become inflamed + narrow (bronchospasm = common)
• reduced airflow in airways
• reversible damage

> Chronic (included in COPD umbrella)
- fixed damage post exacerbation

> Symptoms

• Breathlessness
• Wheeze
• Tightness in Chest

Question 6

Risk Factors for COPD

Answer 6

> Smoking (20 pack years+)
Occupational exposure
Genetic link (alpha-1 Antitrypsin deficiency)
Social deprivation

Question 7

Diagnosing COPD

Answer 7

> Detailed patient history 
> Clinical signs
- Breathlessness on exertion 
- Cough 
- Increased Sputum 
\+Rule out other causes 

> Spirometry (diagnose/classify/monitor)
- Normal FVC 
- Reduced FEV1/FVC ratio <70%
- Reduced FEV1 (degree determines classification)
\: >80% = normal 
\: 80 = mild
\: 50-80%= moderate
\: 30-50% = severe
\: V.severe= <30%

> Chest X ray

*Early diagnosis = key (screen at risk groups)

Question 8

Classification

Answer 8

Early COPD (few symptoms)
- morning cough 
- chest infections in winter 
- breathlessness on vigorous exertion 
> Clinical Exam may appear normal 
> Spirometry may be reduced 

Moderate COPD (Range of symptoms)
- Cough 
- Wheeze
- Shortness of breath with moderate exertion
> Clinical exam 
- Wheeze
- Barrel chest 
> Chest X-ray (flattened diaphragm)

Severe COPD (severe symptoms)

• Cyanosis
• weight loss
• peripheral oedema
• overuse of accessory muscles

Question 9

Treatment for COPD

Answer 9

> Smoking Cessation (help/advice + nicotine replacement)

> Medication
- Inhaler (aerosol or dry powder)
+ spacers to maximise uptake and reduce side effects
- Steroids - reduce inflammation (osteoporosis risk)
- Anti-biotics
- Anti-inflammatories
- Bronchodilators (decrease bronchospasm)
*side effects = fine tremor or heart palpitations
- Mucolytics - break down sputum
- Vaccines - prevent flu + pneumonia

> Pulmonary Rehabilitation

• Exercise
• Diet
• Lifestyle modifications
• Education
• self management strategies

*Overall aim is to reduce admissions + decrease recovery time

Question 10

COPD link to systemic inflammation

Answer 10

> associated with:

• skeletal muscle dysfunction
• CV disease
• Osteoporosis
• Depression
• Cancer
• Fatigue
• Weight loss