COPD

Question 1

Host risk factors for COPD

Answer 1

Genes- alpha1-antitrypsin deficiency

Hyperresponsiveness

Lung growth

Question 2

Exposure risks for COPD

Answer 2

Tobacco smoke exposure

Occupational dusts and chemicals

Question 3

Irreversible causes of airflow limitations

Answer 3

Alveolar destruction- loss of elastic recoil

Fibrosis of airways

Destruction of alveolar support that maintains their patency

Question 4

Reversible causes of airflow limitations

Answer 4

Accumulation of inflammation products:
Inflammatory cells
Mucus
Plasma exudate

Smooth muscle contraction in central and peripheral airways

Dynamic hyperinflation during exercise.

Question 5

COPD airflow limitation

Answer 5

Completely irreversible

Airway is inflamed due to:
CD8+ T cells
Macrophages
Neutrophils

Question 6

Symptoms of COPD for diagnosis

Answer 6

Exertional breathlessness

Chronic cough

Regular sputum production

Wheezing

Frequent winter bronchitis

Question 7

Factors that more likely diagnoses patient with COPD

Answer 7

Age: over 35

Smoker

Persistent and progressive breathlessness

Chronic productive cough

Question 8

Diagnosing COPD, spirometry

Answer 8

Flow-rate will show obstruction.

Post bronchodilator FEV1/FVC ratio will be <0.7

Question 9

GOLD brief intervention for COPD

Answer 9

ASK- identify tobacco users

ADVICE- against tobacco usage

ASSESS- determine willingness to make an attempt to quit

ASSIST- help the patient quit

ARRANGE- schedule follow up

Question 10

Helping smoking cessation

Answer 10

All COPD patients still smoking should be urged to stop smoking.

Nicotine replacement- varenicline/ bupropion

Support programme suggestion

Question 11

Pulmonary rehab

Answer 11

A programme individually catered to each COPD patient that involves multidisciplinary contributions.

Helps to optimise physical, social and autonomy performance.

This is offered to all appropriate people.

Question 12

Bronchodilators in stable COPD

Answer 12

Inhaled therapy that manage COPD symptoms:

Beta-2 agonist

Anticholinergic

Theophylline

Question 13

Theophylline

Answer 13

Used as bronchodilator- relaxes bronchial walls

However side effects are common but little evidence for its use

Question 14

Oxygen therapy for COPD

Answer 14

Long-term administration of O2, >15 hours a day.

PO2 7.3 kPa or less on 2 separate occasions

PO2 7.3-8.0 kPa in pulmonary HT

Question 15

Novel treatments for COPD

Answer 15

Lung volume reduction surgery

Endobronchial valves- allows full expulsion of air. It is one way- expiration.

Transpleural airway bypass-