COPD

Question 1

What is COPD?

Answer 1

A disease characterised by progressive airflow limitation that is not fully reversible.

Question 2

What does COPD include?

Answer 2

Chronic bronchitis

Emphysema

Question 3

What can COPD lead to?

Answer 3

Pulmonary hypertension
Cynosis
Hypoxia
Right heat failure

Question 4

How is chronic bronchitis diagnosed?

Answer 4

Clinical diagnosis- daily productive cough for 3 months or more in at least 2 consecutive years

Question 5

How is emphysema diagnosed?

Answer 5

Pathological diagnosis- permanent enlargement and destruction of airspaces distal to the terminal bronchiole

Question 6

What are the typical characteristics of someone with chronic bronchitis?

Answer 6

Overweight and cyanotic.
Elevated haemoglobin.
Peripheral edema.
Rhonchi and wheezing

Question 7

What are the typical characteristics of someone with emphysema?

Answer 7

Older and thin.
Severe dyspnea.
Quiet chest.
X-ray hyperinfiltration with flattened diaphragms

Question 8

What is the UK prevalence of COPD?

Answer 8

1.5%

Question 9

What are the risk factors to COPD?

Answer 9

Tobacco smoke.
Urban pollution.
Industrial pollution.
Textile dust.
Biomass fuels.

Question 10

What is found in the sputum of i) COPD patients ii) Asthma patients?

Answer 10

COPD-Neutrophil

Asthma-eosinophil

Question 11

Does COPD have limited or marked hyper-responsiveness?

Answer 11

Limited

Question 12

What are the mechanisms of airflow reduction in COPD?

Answer 12

Occlusion of airway by mucus.
Thickened airway wall.
Loss of elasticity due to emphysema.

Question 13

What cells form mucus?

Answer 13

Mucous glands

Goblet cells

Question 14

What is mucus production controlled by?

Answer 14

Neuronal input and inflammatory mediators

Question 15

What is there an increased production of in COPD?

Answer 15

Inflammatory cells
Oxidative stress
Viral infection
Bacterial infection

Question 16

What is there a decreased elimination of in COPD?

Answer 16

Poor ciliary clearance
Airway occlusion
Reduced PEF
Resp muscle weakness

Question 17

What is mucus secretion regulated by?

Answer 17

Sensory nerve (inhaled irritants-NK1)
Cholinergic nerve-M3
Adrenergic nerve-NA-adrenal gland

Question 18

Are neutrophil numbers elevated or lowered in COPD during infection?

Answer 18

Elevated

Question 19

What is the consequence of epithelial damage?

Answer 19

Decrease ciliary cell function.
Increase mucus secretion from goblet cells.
Mucus cell hyperplasia,
Increased bronchial permeability.

Question 20

What is a cough?

Answer 20

Motor reflex in response to sensing chemicals, particulates and airway excessive mucus.

Question 21

What are effective at suppressing a cough?

Answer 21

High dose opioids

Question 22

What is emphysema?

Answer 22

Permanent enlargement of airspaces distal to the terminal bronchiole-destruction of alveolar walls

Question 23

What has been associated with emphysema?

Answer 23

Decreased serum a1 proteins

Question 24

What are lung elastases derived from?

Answer 24

Neutrophils and macrophages

Question 25

What do lung elastases degrade?

Answer 25

Elastin, basement membrane and connective tissue

Question 26

What cytokines are increased in COPD sputum?

Answer 26

TNF and IL-8

Question 27

What does TNF do ?

Answer 27

Increases mucin secretion from epithelium and induces elastase production

Question 28

What do macrophages and neutrophils release in COPD?

Answer 28

Proteases

Reactive oxidant species

Question 29

What do proteases do in COPD?

Answer 29

Break down connective tissue.

Stimulate mucus hypersecretion

Question 30

What do reactive oxidant species do?

Answer 30

Damage epithelium

Activate inflammatory genes

Question 31

What are TGFb and EGF?

Answer 31

Fibroblast growth factors