COPD

Question 1

How is COPD diagnosed?

Answer 1

FEV1 <80% not reversible with bronchodilator

FEV1/FVC < 0.7

Question 2

What are the GOLD criteria for COPD?

Answer 2

Mild - FEV/FVC <0.7 and FEV1>80%
Moderate < 0.7 50-80
Severe <0.7 30-50
Very severe <0.7 <30

Question 3

What is the prevalence of COPD worldwide and UK? How many does it kill?

Answer 3

210 million worldwide
1 million UK (2 million undiagnosed, 1/8 over 35s have it)
Kills 4 million (3rd biggest killer)

Question 4

What are the risk factors for COPD?

Answer 4

Smoking
Genetics
Age
Pollution - environmental, occupation, indoors

Question 5

What is emphysema?

Answer 5

Destruction of terminal bronchioles and distal airspaces lessening alveolar surface area and gas exchange
Destruction of supporting tissue causes airways to close in expiration and destruction of elastic tissue causes hyperinflation

Question 6

What is chronic bronchitis?

Answer 6

Chronic mucus hyper secretion due to inflammation (from smoking) increasing mucus producing cells

Question 7

Explain HPV

Answer 7

Less oxygen in lungs so arteries constrict, increase pulmonary artery pressure, increasing RV afterload, decreasing LV EDV and thus decreasing CO

Question 8

Explain air trapping in COPD

Shit question

Answer 8

Less inspiratory capacity
Diaphragm is flattened causing increased breathing cost (40% not 15%)
Decrease inspiratory reserve volume
Increased recoil pressure (not sure why) so more work for inspiratory muscles

Question 9

What is the effect of COPD on exercise?

Answer 9

Impaired ability to empty lung in exercise reducing the tolerance
Air trap - hyperinflation - dyspnoea - anxiety - tachypnoea - hypoxia - air trap
Deconditioning

Question 10

What is the effect of PA on COPD?

Answer 10

Reduce hospital admission (30-40%) and mortality (27%)

Question 11

What is the effect of COPD on skeletal muscle and why?

Answer 11

Dysfunction - less strength, less GLUT4/MCT4, less type In fibres
Disuse, medication, hypoxia/hypercapnia, malnutrition, oxidative stress

Question 12

Why is exercise limited in COPD?

Answer 12

Respiratory - less air out (hyperinflation) and in (increased cost), dyspnoea, anxiety, mucous
Cardiovascular - polycythaemia, lower CO
MSK - muscle dysfunction
Infection and comorbidities

Question 13

What is pulmonary rehab?

Answer 13

Comprehensive multidisciplinary approach to reduce symptoms, improve functionality and QOL
Lifelong management

Question 14

What are the components of pulmonary rehab (4)

Answer 14

Exercise, educate, psychosocial/behavioural, outcome assessment

Question 15

What are some goals of pulmonary rehab?

Answer 15

Decrease cost of breathing and health costs
Increase pulmonary function, efficiency, exercise capacity, life length and quality
Improve blood gases, dyspnoea, nutrition, emotional wellbeing

Question 16

How effective is education for COPD?

Answer 16

Reduced hospital admissions by 40%

Question 17

How effective is pulmonary rehab for COPD?

Answer 17

Clinically meaningful improvements made

Cost effective - save $344 per patient

Question 18

What is recommended exercise for COPD?

Answer 18

Dyspnoea scale 2-3
>50% peak VO2
Circuits 1-10, 5-10 mins, with rest intervals, 3-5 days
Increase work length then decrease rest

Question 19

What is COPD?

Answer 19

A condition that makes it harder to breathe due to damage to airways and destruction of lung tissue
Preventable, poorly reversible and progressive condition
Chronic bronchitis and emphysema