COPD

Question 0

Define COPD

Answer 0

Progressive airway obstruction
Predominantly caused by smoking
Not fully reversible
Chronic bronchitis, emphysema

Question 1

Describe the main causes of COPD

Answer 1

Smoking
Genetic (a1-antitrypsin deficiency)
Occupational exposure
Pollution

Question 2

Describe the causes and nature of air flow obstruction in COPD

Answer 2

Emphysema:
Destruction of terminal bronchioles and distal air spaces
Loss of alveolar SA
Development of large, redundant air spaces (bullae)
Destruction of surrounding supporting tissue - close during expiration
Loss of elastic tissue –> hyper inflated lungs
Chronic bronchitis:
Inflammation in large airways –> proliferation of goblet cells –> mucus hyper secretion
Remodelling and narrowing of airways

Question 3

Describe the symptoms and signs of COPD

Answer 3

Symptoms - productive cough, progressive breathlessness, exacerbations
Signs - purse lip breathing, hyperinflation (barrel chest), cyanosis, CO2 retention, right heart failure

Question 4

Outline the investigation of COPD patients

Answer 4

Spirometry - obstructive deficit (staging of mild/moderate/severe)
CXR
HRCT - assess degree of emphysema
ABG - respiratory failure
a1 antitrypsin blood test (for younger patients)

Question 5

Outline the management of COPD

Answer 5

Stable disease management - smoking cessation, drug therapy, pulmonary rehabilitation
Drug therapy - bronchodilators, steroids, antmuscarinics, mucolytics, methylxantines
Long term oxygen therapy - 16h/day, offered if pO2 <7.3kPa
Lung volume reduction
Lung transplant