COPD

Question 1

symptoms of copd

Answer 1

wheezing
persistent cough
sputum production
infective exacerbations

Question 2

what are the components of copd

Answer 2

Small airway disease
emphysema
chronic bronchitis

Question 3

common causes

Answer 3

smoking
air pollution
chest infection
nutrition
genetics

Question 4

what is the multi component process

Answer 4

• The 3 main processes that are happening are mucociliary dysfunction, inflammation and tissue damage
• Each one exacerbates condition of the other
• Combination of three leads to obstruction of airway
• Leads to characteristics of disease e.g. exacerbations

Question 5

what is chronic bronchitis

Answer 5

exposure to harmful chemicals leads to excessive mucus.
hypertrophy increase in size of submucosal glands increased mucus production
increase in goblets cells more mucus

Question 6

what is the natural cause of copd

Answer 6

1) Initial breathlessness (dyspnoea) during exercise but then later during rest
2) Cough and sputum production mainly in the morning but later all day
3) Acute respiratory infections occurring frequently, mostly in the winter with exacerbation of symptoms
4) Hypoxia initially in exercise, but then later during sleep and at rets during the day, leading to pulmonary hypertension
5) Chronic respiratory failure, right ventricular heart disease
6) Then terminal acute respiratory failure

Question 7

what are the treatment goals of copd

Answer 7

prevent exacerbation
prevent disease progression
relieve symptoms
improve QOL

Question 8

how to prevent smoking in copd

Answer 8

nictoine replacement i.e gum inhaler
bupropion a nicotinic ach receptor agonist

Question 9

moa of anticholinergics

Answer 9

1) Release of Ach from vagus nerves
2) Some Ach goes and binds to M3 receptor causing contraction
3) Some of Ach binds to M2 on presynaptic terminal of vagus nerves inhibiting further release of ach (negative feedback loop)
In COPD
1) Narrowing of lumen in airways due to inflammation
2) Release of Ach from vagus nerves, binds to M3 receptor . causing more narrowing of lumen as it constricts muscles, restricting airways
3) Anticholinergics block receptors, by binding to receptors
4) Prevents Ach from binding to receptors, Ach removed, no muscle contraction, airway open.

Question 10

moa of rumiflast

Answer 10

• When cAMP produced its broken down to amp by phosphodiesterase type 4 enzyme
• Roflumilast inhibits phosphodiesterase 4, meaning breakdown of cAMP is blocked so cAMP accumulates
• Increase in cAMP in cells improves tissue remodelling by inhibiting fibroblast and inhibiting inflammatory pathways
• Negative pathways restored in normal function with roflumilast

Question 11

first line treatment of copd

Answer 11

offer a SABA or SAMA to relieve breathlessness associated with activities. For example - Salbutamol 100 micrograms (DPI where possible, use in-check dial to decide) 2 puffs PRN or Ipratropium bromide (MDI) 2puffs QDSPRN.

Question 12

what are the lines of treatment of copd

Answer 12

1. vaccination
2. add bronchodilator ( salbutamol or ipratropium)
3. add LABA ( salmeterol or tiotropium)
4. add roflumilast
5. add pxygen therapy