COPD

Question 1

What is COPD?

Answer 1

Progressive and irreversible condition of the lung characterized by chronic
obstruction to air flow.

• destruction of small airways( bronchioles) which lead to losing the function of lung ( ventilation)

Question 2

What is the main risk factor of copd?

Answer 2

Smoking smoking smoking

Question 3

What is the genetic cause of copd?

Answer 3

a1-antitrypsin deficiency ( its main function is the inhbit the function of

Question 4

How do we diagnose chronic bronchitis?

Answer 4

By clinical diagnosis which are It comes with
chronic cough , productive of sputum for at least
3 months per year for at least 2 consecutive years.

Question 5

What are the types of copd?

Answer 5

1-Chronic bronchitis.

2- emphysema

Question 6

How does emphysema occur?

Answer 6

Emphysema : It is s a pathologic diagnosis of permanent enlargement of air spaces distal
to terminal bronchioles due to destruction of alveolar walls.

1-Which maybe due risk factor of genetics.
2- progression of chronic
bronchitis.

Classified by the pattern of the enlarged airspaces:
o Centriacinar
o Panacinar
o Paraseptal

Question 7

What are the risk factors of copd?

Answer 7

1- The most important is smoking.
2- Air pollution
3- occupational exposure like dust.
4. low-birth-weight( may reduce maximally attained lung function.
5- infections
6- low socio-economic status

Also genetics which are alpha1-antitrypsin deficiency.

Question 8

What happen in chronic copd?

Answer 8

weight loss and skeletal muscle
dysfunction

Commonly associated comorbid conditions include cardiovascular
disease, cerebrovascular disease, the metabolic syndrome
osteoporosis, depression and lung cancer.

Question 9

What is hyperinflation?

Answer 9

Occurring when air gets trapped in the lungs and causes them to overinflate.
it occurs by blockage in the air passages or by air sacs that are less elastic which interferes with the explosion of air from the lungs

Question 10

What are the signs of chronic bronchitis ?

Answer 10

1- chronic bronchitis
A) cyanosis
B) peripheral edema from RHF ( cor pulomnale)
C) crackles and wheezing.
D) prolonged expiration
E) frequntly obese.

Question 11

What are the signs of emphysema?

Answer 11

1-Pink skin.
2- accessory muscle use .
3-hyperinflation( barrel chest )
4-hyperresonance in percussion
Cachectic appearance ( lose weight and muscle mass) due to calorie consumption form increased of breathing.
5- decreased breath sound.

Question 12

Why do we hear muffled heart sound?

Answer 12

Due to hyperinflation

Question 13

What is the gold investigation in COPD ?

Answer 13

High-resolution computed tomography HRRCT

Question 14

What is the purpose of PFT in copd?

Answer 14

Decreased FEV1 and decreased FEV1/FVC ratio GOLD staging is based on FEV1.
o ≥80% of predicted value is mild disease
o 50% to 80% is moderate disease
o 30% to 50% is severe disease
o <30% is very severe disease.( mortality is 80%)

Inversible airway obstruction after bronchodilators

Question 15

What is the purpose of chest x ray in COPD?

Answer 15

Low sensitivity for diagnosing COPD
only severe, advanced emphysema will show the typical changes, which
include:
o Hyperinflation
o Flattened diaphragm
o Enlarged retrosternal space
o Diminished vascular markings
Useful in an acute exacerbation to rule out complications
o Pneumonia
o Pneumothorax
o Pneumomediastinum
o Foreign body

Question 16

What is the treatment that improves the mortality in copd?

Answer 16

Is oxygen therapy

Question 17

Why do we need to keep the oxygen level between 88 and 92?

Answer 17

Too much in oxygen will worse the co retention.

Question 18

What is the management of copd?

Answer 18

1- smoking cessation: the most important intervention, prolongs the survival rate but does not reduce it to the level of someone who has never smoked.
2- Bronchodilators :
o Short-acting bronchodilators may be used for patients with mild disease
o longer-acting bronchodilators are usually more appropriate for those with moderate to severe disease.
3-Combined inhaled glucocorticoids( less than 5- 7 days) and bronchodilators :
o Improves lung function
o Reduces the frequency and severity of exacerbations
o Improves quality of life.
4- Oral glucocorticoids :useful during exacerbations
5- Pulmonary rehabilitation .

6****- Oxygen therapy, Long-term oxygen therapy (LTOT) :
o Improves survival in selected patients with COPD complicated by severe hypoxaemia (arterial PaO 2< 7.3 kPa (55 mmHg)
o Minimum 16 hrs /day.

7- Surgical intervention :lung volume reduction surgery (LVRS) or Bullectomy
 Vaccination : annual influenza vaccination and pneumococcal vaccination.
 Antibiotics
 Non-invasive ventilation

Question 19

We don’t give inhaler corticosteroid to copd patients unless it’s acute or on late stage with triple therapy

Question 20

What is differential diagnosis of copd?

Answer 20

Exacerbation Pneumothorax CHF exacerbation Acute MI Pneumonia and other infectious PE

Question 21

Tratment of acute severe copd?

Answer 21

1-Keep saturation 88-92 % and above to prevent more accumulation of CO2 and worsening VQ mismatch •

2-Noninvasive positive pressure ventilation (NPPV) (bilevel positive airway pres- sure [BIPAP] or CPAP).

3- If life-threatening, intubate in ED and refer to ICU admission for ventilation (chance of ventilation dependency)

4-Inhaled β2-agonist (first-line therapy).
• Via nebulizer or MDI
• Assess patient response to bronchodilators (clinically and with peak flows).

5- Corticosteroids
• Traditionally given intravenously initially, but may also be given orally if given in equivalent doses.
• Taper IV or oral corticosteroids, but only when clinical improvement is seen.
• Initiate inhaled corticosteroids at the beginning of the tapering schedule. • Antibiotics • When

the patient stable : Guidelines for treatment are based on severity.

Question 22

What is the indication on intubation?

Answer 22

If a trauma patient the GCS less than 13- 12

But nontrauma patient is between 9-8

Question 23

Copd prognosis?

Answer 23

Prognostic factors:
o frequency and severity of acute exacerbations is the single best predictor
o lung function tests and scores of dyspnea severity
o development of hypoxemia, hypercapnia or cor pulmonale
 5yrsurvival
o FEV1 <1L=50%
o FEV1 <0.75 L = 33%
 BODE index for risk of death in COPD