COPD

Question 1

what are the two main pathological processes in COPD?

Answer 1

• alveolar destruction (emphysema)
• mucus hypersecretion (chronic bronchitis)

Question 2

What percentage of smokers develop COPD?

Answer 2

15-20%

Question 3

What genetic condition affects 2% of COPD patients?

Answer 3

Alpha 1 - antitrpsin deficiency

(suspected with patients <40 yrs old)

(alpha 1 is a protein produced in the liver that acts as an antiprotease in the lungs and inhibits neutrophil elastase)

Question 4

How do noxious particles (including smoking) trigger COPD?

Answer 4

Inflammatory cell activation: stimulates epithelial cells, macrophages and neutrophils to release inflammatory mediators and proteases (neutrophil elastase)

• hyperplasia and hypertrophy of epithelial goblet cells.
• < ciliated cells in epithelium

Question 5

What is neutrophil elastase?

Answer 5

Secreted by neutrophils and macrophages during inflammation, it destroys bacteria and host tissue.

Question 6

What can cause an exacerbation of COPD?

Answer 6

INFECTION

• viral - rhinoviruses, influenza, parainfluenza, coronavirus, adenovirus and respiratory syncytial virus
• bacterial (possibly haemophilus influenzae, streptococcus pneumoniae) Esp. if purulent sputum, and CRP >100 mg/L
• • air pollution, allergens
• smoking

Question 7

COPD and auscultation. What will you find?

Answer 7

• Prolongation of expiration
• Wheeze

Question 8

What’s the leading cause of death in COPD patients?

Answer 8

respiratory failure (type II often)

hypercapnia

Question 9

What’s the relationship beween COPD and RHF?

Answer 9

COPD - pulmonary hypertension - right ventricle hypertrophy and failure

Question 10

What’s the most important advice for COPD patients?

Answer 10

Smoking cessation

(+ pulmonary rehabilitation)

Question 11

What is Ipratropium inhaler an example of?

Answer 11

short-acting anti-cholinergic

Question 12

Give an example of a long acting B2 agonist inhaler

Answer 12

Salmeterol

Question 13

What is tiotropium?

Answer 13

An antimuscarinic bronchodilator

Used for Chronic obstructive pulmonary disease (COPD), severe asthma.

Tiotropium can be helpful in relieving symptoms of chronic obstructive pulmonary disease (COPD).

It is long-acting, which means that its effects last for 24 hours, so you only need to use it once each day. It is not a rescue treatment for sudden breathlessness.

Question 14

COPD - what does a persistent daily productive cough indicate?

Answer 14

underlying chronic bronchitis

Question 15

What is the definition of acute exacerbation of COPD?

Answer 15

“a sustained worsening of symptoms from the stable state”

e.g.

increased cough, breathlessness, sputum production

change in sputum colour

which is..

“more than usual day-to-day variations, acute in onse, may require a change in treatment”

Question 16

What’s the difference between COPD exacerbation and pneumonia?

Answer 16

COPD exacerbation has a clear CXR, pneumonia has consolidation.

COPD exacerbation affects the airways, pneumonia affects the alveoli.

Treatment is different; steroids are used with COPD exacerbation, NOT with pneumonia.

Question 17

What’s the treatment of an exacerbation of COPD?

Answer 17

Oxygen therapy

antibiotics if infection suspected (most common). given orally.

nebulized short-acting bronchodilators

oral corticosteroids; anti-inflammatory action.

Question 18

Which bacteria most commonly cause an exacerbation of COPD?

Answer 18

Haemophilus influenzae

Streptococcus pneumoniae

Moraxella catarrhalis

possible antibiotics; amoxicillin with clavulinic acid, a macrolide (e.g. erythromycin), or a tetracycline (e.g. doxycycline)

Question 19

How can you prevent exacerbation of COPD?

Answer 19

vaccination against streptococcus pneumoniae and influenza organisms.

early treatment.

stop smoking, pulmonary rehab.