COPD

Question 1

What are the key characteristics of COPD?

Answer 1

Alveolar abnormalities
Cigarette smoking
Overinflation of lungs
Low FEV1 that fails to respond to bronchodilators

Question 2

What are the key indicators or symptoms of COPD?

Answer 2

Chronic cough
Chronic sputum production
Dyspnea
Acute bronchitis
History of risk factors

Question 3

When is the usual onset of COPD?

Answer 3

Mid life
over 35 years old

Question 4

What are the structural changes seen in COPD?

Answer 4

Hyperinflation of alveoli
Destruction of alveolar capillary wall
Small airways narrowing
Lung elasticity decreases

Question 5

What are the mechanisms for structural changes of COPD?

Answer 5

Obstruction of small bronchioles
Proteolytic enzymes destroy alveoli tissues (protein breakdown)
Estin and collagen destroyed

Question 6

What is Cor Pulmonale?

Answer 6

Pulmonary hypertension
Enlarge right ventricle due to increased work load
Crackles in lungs due to fluid in alveoli

Question 7

What is polycythemia?

Answer 7

Increase in red blood cells due to hypoxemia and blood becomes more viscous

Question 8

What is the main cause of inflammation in COPD?

Answer 8

Protease/ anti protease imbalance

Question 9

What mediators are seen in COPD?

Answer 9

Macrophages and CD8
Neutrophils

Destructive ones

Question 10

Why is there an increase in reactive oxygen species in COPD?

Answer 10

alpha 1 antitrypsin deficiency

this usually inhibits proteases

Inhibited by cig smoke

Question 11

What proteases cause COPD?

Answer 11

Neutrophil elastase
Cathepsins
Matrix metalloproteinases

Causes emphysema (alveolar destruction)
Mucus hypersecretion (chronic bronchitis)

Question 12

What makes Alpha 1 antitrypsin?

Answer 12

The liver

Deficiency is caused by protein misfolding in genetic ones
Liver damage

Question 13

How do you assess COPD?

Answer 13

Degree of airflow limitation using spirometry
Assess symptoms
Assess risk of exacerbations
Assess comorbidities

Question 14

What post bronchodilator FEV1/FVC confirms COPD?

Answer 14

less than 0.7

relate it to age related norms

Question 15

What gold stage is 50-79 % of expected FEV1?

Answer 15

Gold 2

Question 16

What GOLD stage is 30-49% of FEV1 expectations?

Answer 16

Stage 3

Question 17

What are the requirements for Group A?

Answer 17

mMRC 0-1
CAT under 10
0-1 exacerbations

Question 18

What are the requirements for group E?

Answer 18

2 or more exacerbations leading to hospitalizations

Question 19

What are the treatments used for COPD?

Answer 19

Antimuscarinics
SABA
LABA
PDE4i (Daliresp/roflumilast)
ICSs
Oral steroids
Antibiotics
Oxygen

Question 20

Why are steroid not reccomended for COPD?

Answer 20

immunosuppression - increased risk of infection
Risk of osteoporosis
Does not stop decrease in FEV1

Not for chronic long term treatment

Question 21

What is the mechanism of action of Roflumilast?

Answer 21

Increase cyclic AMP in lung cells by inhibiting PDE4.

Question 22

How does roflumilast help COPD episodes?

Answer 22

Increases lung function by decreasing eosinophils and neutrophils in sputum
Increase FEV1
Has an active metabolite

Use if smoker currently avoid in depression

Question 23

What are the most common causes of COPD episodes?

Answer 23

Viral upper respiratory infection
Infection of the tracheobronchial tree
air pollution

Question 24

What is the goal of COPD treatment?

Answer 24

Minimize the impact of current exacerbation and to prevent the development of subsequent exacerbations

Question 25

What is used for COPD episodes (hospitalizations)?

Answer 25

SABA and anticholinergics
Antibiotics
Non invasive positive pressure ventillation
Long term administration of oxygen