COPD

Question 1

What are the different grades of breathlessness?

Answer 1

0 - only on strenuous exercise
1 - when hurrying on the level or walking up a slight hill
2 - walks slower than others of same age and level. Need to stop when walking at own pace.
3 - after walking few minutes on level or about 100 yards
4 - too breathless to leave house, when dressing.

Question 2

What are some respiratory causes of breathlessness?

Answer 2

Pulmonary embolism, pulmonary fibrosis, COPD, lower RTI, pneumonia, pneumothorax, lung cancer

Question 3

What are some cardiovascular causes of breathlessness?

Answer 3

Dysrhythmias, valvular diseases, acute coronary syndrome, congestive heart failure

Question 4

What are some other causes of breathlessness?

Answer 4

Liver failure, anxiety, anaemia, deconditioning, beta blockers, obesity, aspirin, renal failure

Question 5

What are the three steps in history taking?

Answer 5

History, examination, investigations

Question 6

What is the SOCRATES of history taking?

Answer 6

Site
Onset
Character
Radiation
Associated symptoms
Timing
Exacerbations
Severity
(ICE, family history, past medical history, medication history, lifestyle)

Question 7

What are some examinations used for breathlessness?

Answer 7

Heart, lungs, pulse, BP, BMI
Spirometry/peak flow

Question 8

What are some investigations for breathlessness?

Answer 8

Chest X-ray, blood test for anemia, underactive thyroid or heart failure

Question 9

What is an obstructive lung disease?

Answer 9

More proximal problem (bronchi, bronchioles)
Cannot get air out

Bronchial asthma, COPD, bronchiectasis, bronchiolitis, cystic fibrosis, alpha-1-antitrypsin deficiency

Question 10

What is a restrictive lung disease?

Answer 10

More distal problem (lung parynchema)
Cannot get air in

Extrinsic - neurological, respiratory center depression
Intrinsic - lung fibrosis

Question 11

How is a spirometry test carried out?

Answer 11

1. Height and weight measures
2. Nose is clipped to encourage mouth breathing
3. Blow into mouthpiece connected to spirometer 3 times
4. Spirometer creates graph of lung function

Question 12

What does FEV1/FVC ratio show?

Answer 12

Proportion of FVC expired in 1 second.

Normal is >0.7.

Obstructive is lower than 0.7.

Question 13

What is peak flow rate?

Answer 13

The greatest rate of airflow achieved. Steepest gradient.

Question 14

What are the FEV1/FVC stats for obstructive and restrictive lung diseases?

Answer 14

Restrictive - FEV1/FVC normal, FEV1 lower, FVC lower.

Obstructive - FEV1/FVC lower, FEV1 lower, FVC lower but not as low as FEV1.

Question 15

What 2 conditions contribute to COPD?

Answer 15

Chronic bronchitis and emphysema.
Both triggered by an inflammatory stimulus.

Question 16

What does the typical COPD patient present with?

Answer 16

• middle aged man with extensive history of smoking
• suffering from breathlessness and cough with green or brown sputum

Question 17

What is chronic bronchitis?

Answer 17

• inflammation of bronchiole tubes
• resultant mucus build up causes air trapping and recurrent chest infections
• chronic if produces productive cough for at least 3 months per year for 2 years

Question 18

Why is there so much mucus in bronchitis?

Answer 18

Exposure to irritants and chemicals causes hypertrophy and hyperplasia of bronchial mucinous glands (in main bronchi) and goblet cells (in bronchioles)
Also cilia shorter and less mobile so harder to move mucus.

Question 19

What causes the air trapping?

Answer 19

Obstruction in bronchioles.

Question 20

Summary of bronchitis?

Answer 20

• chronic inflammation
• increase in goblet cells
• mucus gland hypertrophy and hyper secretion
• airway narrowing
• persistent coughing with sputum

Question 21

What causes a green sputum colour?

Answer 21

In chest infections, lots of neutrophils employed.
Neutrophils rich in myeloperoxidase which contains iron.
Iron turns green in mucus.

Question 22

What is emphysema?

Answer 22

Inflammation damages alveolar / small airway walls.
Elastin breakdown causes air trapping and poor gas exchange.

Question 23

What causes elastin breakdown?

Answer 23

Smoking causes lung inflammation, in which neutrophils are involved. Neutrophils release neutrophil elastase, which degrades elastin.

Weakens airway wall causing collapse, so air trapping.
Increases compliance. Lower surface area:volume ratio.

Question 24

Summary of emphysema?

Answer 24

• destruction of airspace walls
• loss of elastic recoil
• enlargement of airspaces
• decreased surface area for exchange
• hyperinflation

Question 25

What are signs of COPD on a chest X-ray?

Answer 25

• more than 7 anterior ribs
• flattening of diaphragm
• heart appears small and narrow

Question 26

What are some non-medical treatments for COPD?

Answer 26

• smoking cessation strategies
• eating a diet with more fat, less carbohydrates
• avoiding lower respiratory tract infections

Question 27

What does the sympathetic nervous system do to the lungs?

Answer 27

Adrenaline/noradrenaline binds to beta 2 receptors, relaxing smooth muscle and dilating airways.

Question 28

What does the parasympathetic nervous system do to the lungs?

Answer 28

Acetylcholine binds to muscarinic 3 receptors, contracting smooth muscle and constricting airways.

Question 29

How do bronchodilators work on the PNS and the SNS?

Answer 29

PNS - antagonise muscarinic receptors, relaxing smooth muscle and dilating airways.
- short acting (ipratroprium bromide) and long acting (tiotropium and glucopyronium) muscarinic antagonists

SNS - activate beta 2 receptors, relaxing smooth muscle and dilating airways.
- short acting beta agonists (salbutamol) or long acting (formeterol and salmeterol)

Question 30

Drug suffixes (-ol vs -ium)

Answer 30

-ol - beta agonist
-ium - muscarinic antagonist

Question 31

Rescue vs maintenance?

Answer 31

Rescue - short acting

Maintenance - long acting

Question 32

What do corticosteroids do?

Answer 32

Anti-inflammatory medications.