COPD

Question 1

What is COPD - chronic bronchitis?

Answer 1

Chronic bronchitis is the lead-in condition, which comes within the diagnosis of COPD.

Defined as a productive cough lasting 3 months or more occurring repeatedly over 2 or more years.

Question 2

What causes COPD - chronic bronchitis? What and the impacts on wellbeing?

Answer 2

Although respiratory viruses are predominantly the cause of acute bronchitis, bear in mind smoking is a key cause of chronic bronchitis, with air
pollution being a minor contributory factor.

Complications:
* Pneumonia
* Development of more significant COPD symptoms

Question 3

What are the signs and symptoms of COPD - chronic bronchitis?

Answer 3

Signs and symptoms – describes acute onset which may then progress onto the chronic picture largely consisting of productive cough

• Cough
• Production of mucus which can be clear, white, yellowish-grey or green in colour — rarely, it may be streaked with blood
• Shortness of breath
• Fatigue
• Chest discomfort
• Mild fever and chills

Question 4

What is the pathophysiology of COPD - chronic bronchitis?

Answer 4

Subsequent to oedema and irritation causing inefficient mucociliary clearance in acute
bronchitis - copious mucous is secreted and irritation persists, especially in alveolar epithelium.

Question 5

What is usual diagnosis and treatment for COPD - chronic bronchitis?

Answer 5

Diagnosis
After case history, key diagnostic tests include:
* Chest X-ray
* Spirometry

Treatment
Conventional treatments tend to involve calming inflammation and opening up the lungs:
* Bronchodilators
* Steroids
* Mucolytics - thin the mucus

Question 6

What is COPD - emphysema?

Answer 6

Although no longer formally defined as distinct from chronic bronchitis, it is important to define emphysema’s specific
presentation and background.

Whereas chronic bronchitis is characterised by persistent airway inflammation, emphysema is more characterised by alveolar destruction

The standard definition of emphysema includes the fact that the alveolar walls have undergone damage to the point of
destruction, causing the air spaces beyond the terminal bronchioles to become permanently enlarged.

Question 7

What causes COPD - emphysema?

Answer 7

Apart from the primary cause of smoking, occupational exposure to, for example, diesel fumes or wood dust contributes to the
development of emphysema.

HIV, Marfan Syndrome, Ehlers-Danlos Syndrome and IV drug use have all been shown to increase risk of developing emphysema

Question 8

What are the signs and symptoms of COPD- emphysema?

Answer 8

Emphysema may remain asymptomatic for a long time during it’s development.

Subsequently, the key symptom is shortness of breath, progressing from exertional to at
rest.

Question 9

What is the pathophysiology of COPD - emphysema?

Answer 9

• Taking the key cause of emphysema as an example - cigarette
  smoke - antigens attack the epithelial lining and the mucociliary system
• Immune cells launch an inflammatory response
• The process of this response transports antigens to lymphatic tissue in the bronchi
• Macrophage release in response to the presence of these antigens initiates
  damage and then destruction of the epithelial barrier of the lung

Question 10

What is the usual diagnosis and treatment for COPD - emphysema?

Answer 10

Diagnosis
* Chest x-ray
* Blood gases
* Spirometry

Treatment
* Bronchodilators
* Steroids
* Antibiotics for secondary infection
* Oxygen (if function poor)
* Pulmonary rehabilitation

Question 11

How can herbs help COPD?

Answer 11

When damage is permanent, herbal focus can be on maximising remaining function eg aiding expectoration, promoting perfusion and circulation. Plantago for mucus membranes, Inula for expectoration.