COPD

Question 1

What is the mechanism of action of tiotropium (spiriva)

Answer 1

It’s an anticholinergic - Blocks M3 muscarinic receptors on smooth muscle cells and submucosal glands to reduce bronchocontriction and mucus secretion

Question 2

Why does lung reduction surgery help in COPD?

Answer 2

Bad lung impinges on good lung

Question 3

In which airways does inflammation generally occur? What is the consequence?

Answer 3

Peripheral

Fibrosis and obliterative bronchiolitis

Question 3

What are some side effects of anticholinergics?

Answer 3

Dry mouth

Question 4

Define COPD

Answer 4

A progressive condition of irreversible airflow limitation due to an ongoing, abnormal inflammatory response to noxious stimuli

Question 4

Describe 4 microscopic aspects of the COPD pathophysiology

Answer 4

Destruction of alveolar septa

Loss of elasticity

Inflammatory cell infiltrate - Neutrophils, macrophages, CD8+

Destruction of pulmonary capillary bed

Question 5

What are some long acting beta2 agonists used in COPD?

Answer 5

Salmeterol

Eformaterol

Indacaterol (ultra long acting)

Question 6

Name some anticholinergics used in COPD (including tradenames)?

Answer 6

Tiotropium (spiriva)

Ipratropium (atrovent)

Question 7

What is chronic bronchitis?

Answer 7

Inhalation of a noxious stimulus that causes production of mucus chronically

Question 8

What therapies can be used in exacerbations?

Answer 8

O2

Antibiotics

Bronchodilators

Corticosteroids

Physical activity

Non-invasive ventilation

Question 9

What is seratide a combination of?

Answer 9

Salmeterol and fluticasone

Question 11

How do you make the diagnosis of COPD?

Answer 11

Spirometry

Question 12

When are inhaled corticosteroids indicated in COPD?

Answer 12

FEV1

Question 13

What is the benefit of oxygen home therapy?

Answer 13

Improves mortality

Reduces pulmonary hypertension

Question 14

Why might FVC be low in COPD lungs?

Answer 14

Gas trapping

Question 15

What are some physical signs of COPD?

Answer 15

Hyperresonance to purcussion

Barrel chest

Dull breath sounds

Question 17

Describe the epidemiology of COPD

Answer 17

3rd leading cause of disease burden in Aus

500,000 Australians have moderate COPD

Question 18

By what factor is FER reduced for COPD to be diagnosed?

Answer 18

FER = <0.7

(FER = FEV1 / FVC)

Question 19

What is pulmonary rehabilitation?

Answer 19

Patients develop mastery of their airways

Question 20

How does the pattern of inflammation differ in asthma cf COPD?

Answer 20

Inflammation affects all airways in asthma

Fibrosis isn’t a major factor in asthma cf in COPD where it is

Question 21

In terms of cell type, what type of inflammation in present in COPD?

Answer 21

Neutrophilic

Question 22

By what method is the severity of COPD graded?

Answer 22

Percentage of predicted FEV1

Question 23

What are some pharmalogical methods of smoking cessation?

Answer 23

Nicotine patches

Bupropion (Zyban)

Varenicline (Champix)

Question 24

When are inhaled steroids indicated in COPD?

Answer 24

When the disease is severe with an FEV1 <50% predicted

Question 25

What is symbicort?

Answer 25

Budesonide and formoterol

Question 26

When is home oxygen therapy indicated?

Answer 26

When PaO2 is <55mmHg or <60mmHg with hypoxic symptoms

No cigarettes for 3 months

Question 27

What are some causes of exacerbations of COPD?

Answer 27

Respiratory infection

Heart failure

Arrhythmia

Systemic infection

Anaemia

Anxiety

Any increase in basal metabolic rate