COPD

Question 1

What is COPD?

Answer 1

Cause airflow obstruction

– Chronic bronchitis
• Affects bronchi
– Emphysema
• Affects alveoli

Question 2

What are the features of chronic bronchitis vs emphysema?

Answer 2

• Chronic Bronchitis
– Productive cough on most days >3 months of the year for 2 consecutive years
– Chronic inflammation of the lower respiratory tract
– Excessive mucous secretion, cough and dyspnea (reduced ciliary function).
– Inflamed airway walls
– Reduced airway radius, increased resistance

• Emphysema
– Damage to alveoli - air space enlargement
– Destruction of lung parenchyma
– Loss of lung elasticity
– Small airway closure
– Reduced airway radius, increased
resistance

Question 3

What are the 3 primary symptoms of COPD?

Answer 3

1) Productive Cough
2) Sputum production
3) Dyspnea on exertion

Question 4

What is the pathophysiology of emphysema vs chronic bronchitis?

Answer 4

Question 5

What is the inflammatory process in COPD?

Answer 5

• Inflammatory response to tobacco smoke
– Neutrophils and macrophages are released
– They release enzymes eg elastase which normally digests microbes /
particles but if enzymes leak into surrounding tissue they may digest lung tissue too
• Elastase breaks down elastin in lung parenchyma
• Lungs normally protected from elastase by a protease inhibitor alpha-1 antitrypsin (AAT)
• Excess inflammation -> excess elastase
– Overwhelms AAT
• Cigarette smoke oxidises part of AAT responsible for binding elastase
– Reduced function of AAT – uninhibited elastase breaks down elastin -> emphysema
• (NB AAT deficiency – genetic disorder – emphysema at early age, however, <1% of COPD cases)

Question 6

What is the most useful question to ask to get an
idea about disease severity?

Answer 6

How much can you do before getting breathless?

Question 7

What is the MRC dsypnoea scale?

Answer 7

Question 8

What would spirometry show in COPD?

Answer 8

Question 9

How can COPD be managed?

Answer 9

• Steroids (inhaler) and systemic used to suppress inflammatory response
• Chronic treatment with systemic glucocorticosteroids should be minimised because
  of an unfavorable benefit-to-risk ratio.
• Patients with COPD benefit from exercise training programs, improving with respect
  to both exercise tolerance and symptoms of dyspnea and fatigue.
• The long-term administration of oxygen (> 15 h per day) to patients with chronic
  respiratory failure has been shown to increase survival

• Salbutamol inhaler
• Ipratropium bromide inhaler
• Beclomethasone inhaler

Question 10

COPD vs asthma

Answer 10