COPD

Question 1

What does COPD stand for?

Answer 1

Chronic obstructive Pulmonary disease

Question 2

What is COPD?

Answer 2

Progressively worsening irreversible airflow limitation

Question 3

Types of COPD?

Answer 3

chronic bronchitis
emphysema
A1AT deficiency

Question 4

RF for COPD

Answer 4

Cigarettes
air pollution
genetics (A1AT def = auto recessive)
Older males

Question 5

Pathology of chronic bronchitis?
What is it?
What does it cause?

Answer 5

Hypertrophy and hyperplasia of mucous glands due to cigarettes

Chronic inflammation cells infiltrate bronchi + bronchioles = luminal narrowing

Mucous hyper secretion, ciliary dysfunction, narrowed lumen (and increased infection risk + airway trapping)

Low O2 = blue

Cough for 3+ months over 2+ years
BLUE BLOATER

Question 6

Pathology of Emphysema?
What is it?
What does it cause?

Answer 6

Pink Puffer (muscle wasting and prominent thoracic cage)

Destruction of elastin layer in alveolar ducts/sacs/resp bronchioles

Elastin keeps walls open during expiration (Bernoulli principle)

low elastin = air trapping distal to blockage (large air sacs = Bullae)

Question 7

What are the 4 types of emphysema?

Answer 7

Centriacinar emphysema (resp bronchioles only) - smokers - v common

Panacinar emphysema (RB, alv ducts, secs) - A1AT def, more severe

Distal Acinar

Irregular

Question 8

What is A1AT def?

Answer 8

Autosomal codominant inheritance

A1 anti trypsin = degrades NE (neutrophil elastase) - protects excess damage to elastin layer esp in lungs

Def (decreased liver production) = high NE = panacinar emphysema and liver issues

Question 9

Who should be suspected of A1AT def?

Answer 9

in younger/middle aged men with COPD Sx but no smoking Hx

Question 10

What are the 2 organisms causing infective exacerbations?
Tx for those?

Answer 10

H.influenzae
S.pneumonae

Abx = Amoxicillin

Question 11

Sx of COPD?
Typical Px?

Answer 11

Older Px, chronic cough with (often) purulent sputum + extensive smoking Hx (except A1AT)
Constant dyspnoea (SOB) - not episodic

Question 12

Sx of blue bloater?

Answer 12

Chronic purulent cough
Dyspnoea
Cyanosis
Obesity

Question 13

Sx of pink puffer?

Answer 13

Minimal cough
pursed lip breathing
Cachectic - muscle waste, low body mass
Barrel chest (over fill with air, work harder)
Hyperresonant percussion

Question 14

Complication of pink puffer?

Answer 14

Bullae rupture (if sub pleural = pneumothorax)

Question 15

Complication of COPD?

Answer 15

Cor pulmonale
RHS heart failure due to high portal htn + high infection risk

Question 16

Dx of COPD?

Answer 16

Pulmonary function test
fractional expired no increased (lung damage)
(FEV1:FVC <0.7) Obstruction on PFT spirometry

Question 17

Bronchodilator?
Reversible?
? high FEV1 = ?

Answer 17

Bronchodilator
Irreversible
<12% high FEV1 = COPD

Bronchodilator
reversible
>12% high FEV1 = Asthma

Question 18

Investigations for COPD?
What may they show?

Answer 18

ABG - May show T2 resp failure
ECG
Chest X ray - may show flattened diaphragm + bullae formation
Genetic test for A1AT def

Question 19

What is the DiCO (diffusing capacity of CO across lung) in COPD + asthma?

Answer 19

LOW in COPD
NORMAL in asthma

Question 20

1st line Tx for COPD

Answer 20

smoking cessation + vaccines for influenza and pneumococcal

Question 21

Long term pharmacological Tx?

Answer 21

1. SAB2A (salbuterol)
2. SAB2A + LAB2A (salmeterol) + LAM3A (Tiotropium)
3. SAB2A + LAB2A + LAM3A + ICS (inhaled corticosteroid eg. beclometasone)

Consider long term O2 if very severe, 15+ hr a day for 3 weeks when <88% (55mmHg) or <90% (60mmHg) with heart failure

Question 22

What are the O2 targets for COPD?

Answer 22

88-92% sats