COPD

Question 1

Definition

Answer 1

Is a pulmonary obstruction of the airways caused by exposure of toxic particles & gases

Question 2

Causes/ Etiology

Answer 2

Smoking, occupational dust, aging, pollution, genes, empysema

Question 3

Pathophysiology

Answer 3

Inflammatory reaction of the alveoli due to obstruction, changing anatomical structure, leading to fibrosis and thick bronchial wall

Question 4

Symptoms

Answer 4

wheezing
dyspnea
cough + sputum
weight loss
fatigue
exacerbations

Question 5

Diagnosis

Answer 5

(dec)FEV1 - spirometry (post bronchial dilatation)
symptoms, history, work place, comorbidities
(dec) alpha 1-antigen

►Spirometry is required to make the diagnosis; the
presence of a post-bronchodilator FEV1/FVC < 0.7
confirms the presence of persistent airflow limitation.

Question 6

Classification

Answer 6

GOLD
Mild - FEV 1- >80%
Moderate - FEV 1- 50-80%
Severe - FEV 1- 30-50%
Very Severe - FEV 1- <30%

CAT (if happy/no - if cough/no - if chest thigh- if dyspnea - if sound to sleep - if energy)
MCR (dyspnea scale 0-4 only when extremely exercise, or cannot even leave the house)

Question 7

Management/ Treatment

Answer 7

Stop smoking, vaccination, diet, in some cases oxygen therapy
A S/L bronchodilator (SABA or LABA)
B Long acting BD (LABA or LAMA)
C LAMA
D LAMA or LAMA + LABA or ICS + LABA

Question 8

Management exacerbations

Answer 8

Mild (SABS only)
Mod (SABA + antibiotics + oral corticosteroids)
Severe (hospitalization/visit emergency room) associated with acute respiratory failure
►Blood eosinophil count may also predict exacerbation
rates (in patients treated with LABA without ICS).

Question 9

Complications

Answer 9

Respiratory failure

The progression of COPD leads to the loss of a reversible component (edema of the bronchial mucosa, spasm of smooth muscles, mucus secretion) and an increase in irreversible changes leading to the development of peribronchial fibrosis and emphysema.

The course of COPD is aggravated by a gas exchange disorder, manifested by a decrease in O2 and CO2 retention in arterial blood, an increase in pressure in the pulmonary artery and leading to the formation of cor pulmonale . Chronic cor pulmonale causes circulatory failure and death in 30% of patients with COPD.