COPD

Question 1

COPD definition

Answer 1

A chronic, slowly progressive disorder characterised by airflow obstruction that does not change markedly over several months.

Question 2

Chronic bronchitis definition

Answer 2

Large airways have mucous gland hyperplasia, goblet cell hyperplasia and some inflammation and fibrosis.
In small airways, goblet cells appear and inflammation and fibrosis.

Question 3

Emphysema definition

Answer 3

Loss of alveolar attachments.

Increase in size of air spaces due to dilatation or destruction of walls.

Question 4

Pathology of emphysema

Answer 4

More destruction of elastin around alveoli by elastase due to decreased anti-elastase by alpha-1-antitrypsin deficiency and smoking and decreased elastin repair mechanisms and increased neutrophil and macrophage production due to smoking.

Question 5

What are the types of emphysema

Answer 5

Centriacinar - apex from bronchi
Panacinar - at base
Periacinar - can cause pneumothorax. When air spaces are over 1cm and form bullous or bleb

Question 6

Risk factors

Answer 6

SMOKING
atmospheric pollution
occupation - dust
age
male

Question 7

Symptoms

Answer 7

Breathlessness

Cough and recurrent chest infection

Question 8

Signs

Answer 8

Reduced chest expansion
Prolonged expiration/wheeze
Hyperinflated chest
Respiratory failure - tachypnoea, cyanosis, use of accessory muscles to breathe, pursed lip breathing, peripheral oedema

Weight loss
Loss of muscle muss
Cardiac disease
Depression
Anxiety

Question 9

Investigations

Answer 9

Spirometry
Chest x-ray
Full blood count
ECG

Question 10

Management

Answer 10

Smoking cessation
Vaccinations (flu)
Inhalers to relieve breathlessness
Pulmonary rehabilitation
Psychological support
Long term oxygen therapy