COPD

Question 1

What does COPD stand for?

Answer 1

Chronic Obstructive Pulmonary disease

Question 2

Is COPD acute or chronic?

Answer 2

It is a chronic disease and is recurrent throughout lifetime and persists through life. However, when he disease does recur, the airway obstruction is acute.

Question 3

COPD?

Answer 3

persistent chronic inflammation of the airway, parenchyma and vasculature

Question 4

Parenchyma?

Answer 4

epithelial cells involves in gas exchange at the alveolar level

Question 5

Vasculature?

Answer 5

vessels involves in gas exchange ex. pulmonary capillaries

Question 6

COPD includes a combination of diseases. List them.

Answer 6

1. chronic bronchitis
2. emphysema
   (neither of these are fully reversible and usually coexist)
   (may also coexist with asthma, however, asthma is reversible)

Question 7

Is mucus beneficial?

Answer 7

Yes, but if you have increased secretion of mucus it is a problem.

Question 8

Etiology/risks of COPD

Answer 8

• Smoking
• Ageing
• Recurrent Respiratory infections
• genetic deficiency of alpha 1 antitrypsin
• increased compliance or decreased compliance

Question 9

What is the prevalence of smoking as a risk/etiology to COPD?

Answer 9

80-90% of COPD cases are linked directly to smoking

Question 10

Cigarette smoke contains a variety of irritants that contribute to COPD. List 4.

Answer 10

1. When the respiratory tract gets irritated, goblet cells in the epithelial lining increase mucus production as a normal defense mechanism to protect the airway lining. However, the increase in mucus can impede gas exchange. The mucociliary blanket created by the pseudostratified ciliated columnar epithelium lining the trachea is also a defense mechanism. Goblet cells produce mucus that traps air and cilia beat in the direction of the mouth, expectorate mucus containing debris and microbes. BUT, hyper secretion of mucus overwhelms the cilia and they aren’t able to sweep up harmful debris.
2. Irritants in smoke also damage cilia
3. irritants induce coughing -> a defense mechanism to expectorate harmful material. However, when coughing I constant and repetitive, it can damage the lining of the airway. Coughing can shoot air out at 100-160km/hr damaging the tissues with this force.
4. the irritated respiratory tissue becomes inflamed, which leads to inflammatory damage. (Not only damaging the airways, but the walls between the alveoli)

Question 11

How does ageing contribute to COPD?

Answer 11

ageing -> degeneration of tissue = decrease in elasticity and compliance

Question 12

Compliance?

Answer 12

It refers to the ease at which you can inflate the lungs

Question 13

Elasticity?

Answer 13

requires recoil which allows the lungs to deflate

Question 14

Why do recurrent respiratory infection contribute to COPD?

Answer 14

With infection you are going to have chronic hyper secretion of mucus + coughing + inflammation. With persistent infections, you are going to damage the tissues and lose compliance + elasticity

Question 15

Trypsin?

Answer 15

Breaks down proteins in the gut but also breaks down ageing structures for regeneration of tissue

Question 16

Alpha-1 Antitrypsin?

Answer 16

Opposes the breakdown of protein so that trypsin does not excessively break down useful tissue.

Question 17

What happens if there is a genetic deficiency of alpha-1 antitrypsin?

Answer 17

Functional tissue of the respiratory tract is lost (Trypsin breaks down the walls of the alveoli and capillaries)

Question 18

What happens if there is an increase in compliance?

Answer 18

Lungs become floppy

Question 19

What happens if there is a decrease in compliance?

Answer 19

Can’t deflate the lungs

Question 20

Diagnostics of COPD?

Answer 20

• hx, px
• chest xray
• pulmonary function tests such as spirometry
• labs (CBC, CRP etc)

Question 21

What do you want to focus on when taking a hx and px of the pt who may have COPD?

Answer 21

• breath sounds
• ventilation issues
• SOB
• accessory muscle use
• arms propped on table to facilitate breathing

Question 22

What will you find in a chest xray if the pt has COPD?

Answer 22

• consolidation, damage and decrease volume of lungs

Question 23

Spirometry?

Answer 23

A pulmonary function test that can be used in a doctors office. It identifies an obstructive issue (pointing the clinician towards COPD; chronic bronchitis; emphysema; asthma).

Question 24

What is measured in a spirometry?

Answer 24

Forced vital capacity, Forced expiratory volume in one second, if there is a decrease in the FEV1/FEV ratio, total lung volume and tidal volume

Question 25

FVC?

Answer 25

forced vital capacity = the total volume maximally forcefully exhaled

Question 26

FEV1?

Answer 26

Forced expiratory volume = the total volume of air forcefully exhaled in one second

Question 27

What does a decrease in the FEV1/FVC ratio indicate?

Answer 27

Obstructive problem because a health person should be able to exhale at least 80% of their vital capacity in 1 second.

Question 28

Tidal volume?

Answer 28

Normal volume when no extra effort is used

Question 29

Treatment for COPD

Answer 29

Manage progression of disease:

• smoking cessation
• avoid airway irritants
• vaccines eg. flu shot
• drugs (Stage based; fewer drugs first)
  1. early stages: Short-acting beta agonists or anticholinergic
  2. more advanced COPD: add inhaled steroids
  3. Late stage: Long-Acting beta agonists (with glucocorticoids) or Theophylline (xanthine derivative)

Question 30

What are some examples of airway irritants?

Answer 30

Strong odours, smoke from fires etc

Question 31

Why is it strongly recommended that pts with COPD get vaccinations?

Answer 31

They are more prone to develop infections because their defense mechanisms are compromised.