COPD

Question 1

2 disease processes involved

Answer 1

Emphysema

Chronic Bronchitis

Question 2

Cause

Answer 2

Smoking

Question 3

Principle cell type involved

Answer 3

Neutrophils

Question 4

Aetiology of disease process

Answer 4

Cigarette smoke activates alveolar macrophages which release neutrophils.
Neutrophilic inflammation results in tissue damage and mucociliary dysfunction as cilia are paralysed.
Macrophages and neutrophils release proteases which b/d CT, stimulating mucous hyper secretion.
Then either emphysema or chronic bronchitis occurs.

Question 5

Chronic bronchitis

Answer 5

Chronic neutrophilic inflammation
Mucous hypersecretion
Mucociliary dysfunction
Partially reversible

Question 6

Emphysema

Answer 6

Alveolar wall destruction
Collapsing of alveoli
Impaired gas exchange
Irreversible

Question 7

Clinical presentation

Answer 7

Chronic symptoms, late onset
Daily productive cough - usually clear sputum 
Progressive breathlessness 
Frequent infective exacerbations which include: 
- purulent sputum
- increased sputum production
- chest infection
- increased breathlessness

Question 8

Clinical signs

Answer 8

Wheezing
Reduced breath sounds 
Chest tightness
Hyper-ressonance on percussion
Hyperinflation (emphysema)

Question 9

Common organisms of acute exacerbation

Answer 9

H. Influenzae
M. Catarrhalis
Strep. Pneumonia

Question 10

Investigations

Answer 10

Spirometry - FEV1/FVC determination
Sputum culture
CXR

Question 11

Management of normal COPD

Answer 11

SABA
+ LABA/LAMA
+ LABA + LAMA combo
+ ICS

Question 12

Management of acute exacerbation

Answer 12

Ipratropium
Salbutamol (SABA) 
Oxygen
Antibiotics (1st line = Amoxicillin, 2nd line = Doxycycline)
Prednisolone (oral) 

Only treat exacerbation if :-

• increased purulent sputum
• new CXR changes
• pneumonia suspected

Question 13

SAMA

Answer 13

eg: Ipratropium
Non selective blocker of M1, M2 and M3 receptors
Given by inhalation route 
Relax bronchospasm 
Prevent contraction, allow relaxation 
Decrease mucous secretion

Question 14

LAMA

Answer 14

eg: Tiotropium
Selective blocker of M3 receptors. 
Given by inhalation route
Prevent contraction, allow relaxation 
Decrease mucous secretion

Question 15

Combination inhalers

Answer 15

LABA + LAMA
better than either drug alone
both work by different mechanisms to produce smooth muscle relaxation
LABA - increases cAMP to cause relaxation
LAMA - M3 receptors blocked to inhibit contration and thus allow relaxation

Question 16

FEV1/FVC determination

Answer 16

FEV1 = reduced
FVC = reduced (there will always be a fraction of the air remaining in the lungs) 
FEV1/FVC = reduced