COPD

Question 1

What is COPD?

Answer 1

Chronic airflow obstruction that is slowly progressive - small and large airways are affected, mainly alveoli
Little or no reversibility
Predominantly cased by smoking

Question 2

What are the structural abnormalities in COPD?

Answer 2

Narrowing of airways (due to inflammation)
Enlargement of air spaces distal to terminal bronchioles with destruction of their walls (emphysema) - reduced surface area for gas exchange
Expansion of the chest

Question 3

When is the greatest reduction in airflow?

Answer 3

Expiration - pressure on chest compresses airway

Question 4

Is there dynamic hyperinflation in COPD?

Answer 4

Yes

Question 5

Prior events to COPD?

Answer 5

Smoking
Repeated chest infection
Family history
Exposure to dust/air pollution

Question 6

What is emphysema?

Answer 6

Abnormal, permanent enlargement of airspaces distal to terminal bronchiole accompanied by the destruction of their walls
(think of an aero chocolate bar)

Question 7

Is COPD obstructive or restrictive?

Answer 7

Obstructive

Question 8

How does FEV1 change?

Answer 8

Reduced

Question 9

How does FEV1/FVC ratio change?

Answer 9

Reduced

Question 10

How does FVC change?

Answer 10

Stays the same

Question 11

Will there be variability in peak flow?

Answer 11

Little

Question 12

What are the symptoms of COPD?

Answer 12

Breathlessness (dysponea)
Wheeze
Phlegm
Cough
Unable to walk long distances, particularly up hill
When severe, breathless when dressing etc.

Question 13

What are the clinical signs of COPD?

Answer 13

Tachypnoea 
Hyper-Inflated chest
Wheeze
Breath sounds decreased in intensity 
Prolonged expiration

Question 14

Can alpha 1 anitrypsin deficiency cause emphysema?

Answer 14

Yes

Question 15

How are pack years calculated?

Answer 15

20 cig/day for 1 year = 1 pack year
40 cig/day for 1 year = 2 pack years
40 cig/day for 10 year = 20 pack years

Question 16

What abnormal test results will come back?

Answer 16

Chest x ray - hyperinfalted lungs
Reduced FEV1
Hypoxia
Hypercapnoea

Question 17

What medical intervention should be carried out?

Answer 17

Antibiotics for episodes of infection bronchitis
Beta-2-recpetor agonstist for bronchodilation
Long acting beta 2 - agonists
Anticholinergic bronchodilator therapy (block parasympathetic innervation)
Inhaled steroids
Oral steroids (prednisolone) to stop inflammation
Oxygen therapy

Question 18

Secondary prevention?

Answer 18

Non smoking

Oxygen supplement