COPD

Question 1

what causes COPD

Answer 1

90% is smoking related
other causes can include pollution, fuel smoke

increased susceptibility with alpha1-antitrypsin deficiency

Question 2

macroscopic changes in COPD lungs

Answer 2

increased mucus secreting goblet cells in mucosa
inflammation of bronchi
pus secretion in lumen
emphysema + narrowing = airway limitation

Question 3

microscopic changes in copd lungs

Answer 3

inflammatory cell infiltration of bronchial walls

lymphoid follicle production

Question 4

which airways are usually affected first in copd

Answer 4

small airways

Question 5

what is the effect of chronic inflammation in copd

Answer 5

scarring, thickening and narrowing of airways

Question 6

what is emphysema?

Answer 6

abnormal permanent enlargement of air spaces distal to terminal bronchiole with desruction of walls without obvious fibrosis

Question 7

2 common types of emphysema

Answer 7

centri-acinar emphysema

pan-acinar emphysema

Question 8

describe centri-acinar emphysema

Answer 8

distension and destruction around respiratory bronchioles with preservation of more distal alveolar ducts

Question 9

describe pan-acinar emphysema

Answer 9

distention and destruction affecting entire acinus - forms bullae

Question 10

what is the effect of emphysema on lung function

Answer 10

airflow limitation and V/Q mismatch

Question 11

explain how COPD happens

Answer 11

chronic inflammation causes thickening of walls, causing scarring and narrow of airways

emphysema causes destruction of alveoli causing V/Q mismatch and further airflow limitation. loss of elasticity also causes premature airway collapse and air trapping

chronic mucus secretion also leads to blocking of airways

all these factors lead to obstruction of airway, hyperinflation of lungs, hypoxaemia, hypercapnia

Question 12

why does polycythaemia happen in copd?

Answer 12

renal hypoperfusion/hypoxia causes fluid retention and increased erythrocyte production

Question 13

why does cigarette smoking cause COPD

Answer 13

cigarette smoke causes increase in neutrophil granulocyte production. these cells produce proteases and elastases which damage the air walls

Question 14

why does alpha1-antitrypsin deficiency cause copd

Answer 14

alpha-1-antitrypsin is an important antiprotease, without which the activity of proteases will cause progressive damage to the air ways

Question 15

what is cor pulmonale

Answer 15

pulmonary hypertension

Question 16

signs of cor pulmonale

Answer 16

pulmonary edema
Right ventricular hypertrophy
peripheral edema

severe cor pulmonale -
ascites
hepatomegaly
elevated JVP

Question 17

xray findings in a copd patient

Answer 17

usually normal but can see
hyperinflation
flattened diaphragm

Question 18

level 1 - 5 on the MRS dyspnea scale

Answer 18

1 = sob only on strenuous exertion
2= sob on hills and hurried level walking
3 = walks slower than most people, sob after ~15 mins walking at own pace
4= stops for breah after ~100 yards or few minutes on level ground
5 = too breathless to leave the house or when undressing

Question 19

what is bupropion?

Answer 19

nicotine acetylcholine receptor antagonist - reduces smoking cravings

Question 20

what can be prescribed in smoking cessation programs?

Answer 20

nicotine replacement patches
buproprion
varenicline

Question 21

what can be prescribed to reduced the pleasureable effects of smoking?

Answer 21

varenicline

Question 22

what is the commonly prescribed mucolytic drug?

Answer 22

carbocysteine

Question 23

investigations in exacerbation of COPD

Answer 23

find out if infective or not

CXR
sputum culture
ECG
Blood cultures
ABG
PEF meter

Question 24

differential diagnoses in someone with known COPD presenting with increasing breathlessness, increasing cough, fever,

Answer 24

(I)E of COPD
asthma
heart failure
lung cancer
pneumonia
PE
airway obstruction

Question 25

extrapulmonary symptoms/signs of COPD

Answer 25

cor pulmonale - heart failure/pulmn H/T
osteoporosis
polycythaemia
metabolic disorders - weight loss/muscle wasting