COPD

Question 1

define COPD

Answer 1

progressive disease characterised by airflow limitation that can potentially be reversed

Question 2

causes of COPD

Answer 2

• smoking

- abnormal inflammatory response to noxious particles

Question 3

pathological changes in COPD

Answer 3

• increased mucous secreting cells
• inflammatory cells in bronchi
• scarring and thickening of small airways
• loss of recoil (emphysema)

Question 4

describe emphysema

Answer 4

permanent enlargement of airspaces/alveoli distal to the terminal bronchioles

Question 5

what does alveoli dilatation in emphysema cause?

Answer 5

expiratory airflow limitation

Question 6

are patients with emphysema the pink puffers?

Answer 6

yes

Question 7

explain the pink puffers

Answer 7

• very thin with a barrel chest
• little or no cough
• pursed lips
• use of accessory respiratory muscles
• hyper resonant
• wheezing

Question 8

how does hyperinflation of the lungs occur in emphysema?

Answer 8

loss of elasticity and mucus secretion leads to air trapping

Question 9

how is V/Q mismatch produced in emphysema?

Answer 9

inflammation and scarring

Question 10

describe chronic bronchitis

Answer 10

increased mucus secretion

Question 11

physiology of chronic bronchitis

Answer 11

• low alveolar ventilation (cyanosed, but not SOB)
• low PaO2 and high PaCO2
• rely on hypoxic drive

Question 12

clinical features

Answer 12

• productive cough (white or clear sputum)
• wheeze
• breathlessness
• frequent infections

Question 13

what can occur in the later stages of COPD

Answer 13

respiratory failure due to chronic alveolar hypoxia and hypercapnia

Question 14

investigations into COPD

Answer 14

• clinical examination/ history
• spirometry
• PEFR
• CXR
• blood gases

Question 15

characteristic spirometry result

Answer 15

reduced FEV1

reduced FEV1/FVC

Question 16

PEFR in COPD

Answer 16

reduced

Question 17

CXR in COPD

Answer 17

hyperinflation with a flattened diaphragm

Question 18

blood gases in COPD

Answer 18

normally normal but can get hypercapnia

Question 19

non-pharmacological treatment for COPD

Answer 19

smoking cessation

Question 20

pharmacological treatment of COPD

Answer 20

1. SABA/SAMA (salbutamol or ipratropium)
   =2 if FEV1 more than 50% then LABA or LAMA (salmeterol or tiotroprium)
   =2 if FEV1 less than 50% than LABA + ICS
2. LABA + ICS + LAMA

Question 21

are chronic bronchitis patients the blue bloaters?

Answer 21

yes

Question 22

features of the blue bloaters

Answer 22

• may be obese
• Frequent cough
• Use of accessory muscles
• wheezing
• may have signs of right heart failure (cor pulmonale), such as oedema and cyanosis

Question 23

how does chronic bronchitis cause pulmonary hypertension (cor pulmonale)

Answer 23

fluid retention and peripheral oedema due to failure of sodium excretion