COPD

Question 1

What are the Risk Factors for COPD?

Answer 1

• Cigarette Smoke, quantified in units of packs/year (number of packs per day x number of years smoked)
• Occupational Exposures (organic and inorganic dusts)
• Secondhand smoke
• Urban Pollution

Question 2

What is COPD?

Answer 2

Pathological changes found throughout the pulmonary system secondary to chronic inflammation.

• Airway inflammation causes airway narrowing (significant in smaller peripheral airways)

Question 3

What changes occur to inspiration and expiration in COPD?

Answer 3

Inspiration: airways open allowing air to enter

Expiration: Narrowed airways close prematures, trapping air in the distal airways

Question 4

What volume or capacity is increased secondary to trapping of air causing hyperinflation?

Answer 4

Increases Functional Residual Capacity and RV

Abnormal increase in air within the lungs at end of tidal exhalation.

Question 5

Why does hypoxemia occur?

Answer 5

Due to Ventilation/Perfusion (V/Q) mismatch.

• Decreased amount of oxygen in arterial blood

Question 6

What is Hypercapnia?

Answer 6

Increased amount of Carbon Dioxide within arterial blood

Question 7

What is Cor Pulmonale?

Answer 7

Right Ventricular Hypertrophy, secondary to pulmonary hypertension.

• AKA Right Sided Heart Failure

Question 8

What is Polycythemia?

Answer 8

Increase in the number of circulating red blood cells.

Tries to increase oxygen carrying capacity of the blood.

Question 9

What is the most characteristic symptom of COPD

Answer 9

Dyspnea

Dyspnea may be first be prevalent with exertion. i.e Dyspnea on Exertion

Question 10

Physical Exam Findings; Visual Inspection

Answer 10

Enlarged thorax secondary to hyperinflation and loss of elastic recoil

Increased Anterior-Posterior Diameter

Dorsal Kyphosis

Barrel Chest Appearance

Question 11

How might the diaphragm change in patients with COPD?

Answer 11

Flattening of the diaphragm, cannot return to dome shaped on exhalation.

Question 12

What are the accessory muscles of ventilation

Answer 12

SCM
Scalenes
Trapezius
Pectoralis Minor
Pectoralis Major
Transverse Thoracis
External Intercostals
External and Internal Obliques
Rectus Abdominis

Question 13

Auscultation findings?

Answer 13

Decreased breath and heart sounds

Question 14

Adventitious sounds associated with COPD?

Answer 14

Crackles: intermittent bubbling or popping sounds

Expiratory Wheeze: Musical whistling sound

Question 15

What lung volumes or capacities are increased?

Answer 15

Residual Volume
Functional Residual Capacity

Total Lung Capacity is also increased, due to the increase in Residual Volume

Question 16

How can cigarette smoking be quantified?

Answer 16

Cigarette Smoke, quantified in units of packs/year (number of packs per day x number of years smoked)

Question 17

What ratio of FEV1/FVC is diagnostic for COPD?

Answer 17

FEV1/FVC < 70%

For all Gold Stages, FEV1/FVC is < 70%

Question 18

FEV1 Percentage of Predicted: Gold Stage I (Mild)

Answer 18

FEV1 > 80%

Question 19

FEV1 Percentage of Predicted: Gold Stage II (Moderate)

Answer 19

FEV1 50-80%

“Rule of 30”

Question 20

FEV1 Percentage of Predicted: Gold Stage III (Severe)

Answer 20

FEV1 30-50%

“Rule of 30”

Question 21

FEV1 Percentage of Predicted: Gold Stage IV (Very Severe)

Answer 21

FEV1 < 30%

“Rule of 30”

Question 22

In COPD is Expiratory Reserve Volume increased or Decreased?

Answer 22

DECREASED!