COPD

Question 1

What is the definition of COPD?

Answer 1

Lung disease characterised by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible

Question 2

Describe the epidemiology of COPD

Answer 2

Predicted to climb to 3rd leading cause of death

65 million worldwide

3 million in Uk ( 1/3 undiagnosed)

Question 3

Risk factors of COPD?

Answer 3

Host
Genes- alpha1-antitrypsin deficiency
Hyperresponsiveness
Lung growth

Exposure
Tobacco smoke
Occupational dust and chemicals

Question 4

Outline the pathogenesis of COPD

Answer 4

Noxious particles and gases enter lung

This causes lung inflammation

This either causes oxidative stress or proteinases which both lead to COPD pathology

Question 5

Suggest three targets for drug treatments against COPD

Answer 5

Anti-proteinases

Repair mechanisms

Anti-oxidants

Question 6

Inflammation in the case of COPD leads to airflow limitation describe how.

Answer 6

1. Small airway disease - the airway becomes inflamed and remodelling occurs
2. Parenchymal destruction - loss of alveolar attachements decrease recoil ability

Question 7

Airflow limitation can be both reversible and reversible. Describe how this can occur

Answer 7

IRREVERSIBLE

1. Loss of elastic recoil due to alveolar destruction
2. Destruction of alveolar support
3. Fibrosis and narrowing of airways

REVERSIBLE

1. Accumulation of inflammatory cells, mucus and plasma exudate in bronchi
2. Smooth muscle contraction in peripheral and central airways
3. Dynamic hyperinflation during exercise

Question 8

How does asthma differ to COPD?

Answer 8

Asthma causes airflow limitation that is completely reversible. The cells involved are CD4+ T-lymphocytes and eosinophils

COPD causes airway limitation that is completely irreversible. The cells involved are CD8+ T-lymphocytes, macrophages and neutrophils

Question 9

How is COPD diagnosed?

How does this differ to asthma?

Answer 9

SPIROMETRY

Older than 35 and smoker/ex-smoker and:

Exertional breathlessness
Chronic cough
Regular sputum production
Frequent winter 'bronchitus'
Wheeze

And no clinical signs of asthma
In asthmatics, onset is usually younger than 35, smoking is not necessary, uncommon chronic cough, variable breathlessness(as opposed to persistent, progressive COPD cough) and variability during day and night symptoms

Question 10

How is COPD managed?

Answer 10

Smoking cessation (nicotine replacement therapy)

Pulmonary rehabilitation involves individually tailored MDT programme of care in buildings easily accessible.

Inhaled bronchodilators to manage symptoms
(B2-agonist/anticholinergic/ theophylline- depends on response and availability)

O2 therapy - long term treatment in patients increases survival

Question 11

State two novel treatments for COPD

Answer 11

Lung vlume reduction surgery

Transpleural airway bypass