COPD

Question 1

What two conditions come under the umbrella term of COPD?

Answer 1

Chronic bronchitis

Emphysema

Question 2

Which cells are primarily involved in COPD pathophysiology?

Answer 2

Macrophages
Neutrophils
T cells

Question 3

Describe the cellular changes which occur in COPD

Answer 3

Narrowing and remodelling of the airways
Increased number of goblet cells
Enlargement of mucous secreting glands
Vascular bed changes leading to pulmonary hypertension

Question 4

There is an increase in lung compliance in COPD. How does this occur?

Answer 4

There is elastin breakdown and loss of alveolar integrity. Destruction of the alveolar walls by proteolytic enzymes released by leukocytes decreases alveolar surface area and increase lung compliance

Question 5

How is gas exchange impaired in COPD?

Answer 5

Alveolar wall loss leads to fusion of alveoli to form fewer but larger alveoli with an overall decrease in alveoli surface area which impairs gas exchange

Question 6

What are the risk factors for COPD?

Answer 6

Smoking
Advanced age
Air pollution /occupational exposure
Male sex
Low socioeconomic status
Developmentally abnormal lungs
Alpha 1 trypsin deficiency

Question 7

What are the symptoms of COPD?

Answer 7

Cough usually productive and frequently occurs in the morning
Dyspnoea on exercise and then at rest as disease progresses
Barrel chest due to hyperinflation

Question 8

What are the results of auscultation for COPD?

Answer 8

Hyper-resonance caused by hyperinflation
Distant breath sounds due to hyperinflation and air trapping
Wheezing especially with exacerbations
Coarse crackles due to mucous in airways

Question 9

What are the spirometry results for COPD?

Answer 9

FEv1/FVC ratio of less than 0.70

Question 10

For a patient with COPD when should capillary blood gasses be checked?

Answer 10

When oxygen saturation is less than 92% or when FEV1 is less than 35%

Question 11

What indicators of hyperinflation may be seen on a CXR of a COPD patient?

Answer 11

Increased anterioposterior ratio
Flattened diaphragm
Increased intercostal spaces
Hyperlusent lungs

Question 12

What would be the results of an FBC for a COPD patient?

Answer 12

Possibly a raised haematocrit with increased WBC count

Question 13

What are the first line treatments for COPD patients?

Answer 13

Short or long acting bronchodilator
Patient education
Vaccination - influenza, pnumococcal
Smoking cessation

Question 14

How many pack years minimum do people with COPD usually have?

Answer 14

20

Question 15

What is alpha 1 trypsin?

Answer 15

An antiprotease