COPD

Question 1

Description

Answer 1

Poorly reversible airflow limitation, usually progressive and persistent inflammatory response

Question 2

Types

Answer 2

Blue bloaters, pink puffers

Question 3

Clinical presentation

Answer 3

Chronic cough, breathlessness on exertion, wheezing, sputum production
Abnormal posture, underweight, ankle oedema, drowsiness/mental confusion

Question 4

Chronic bronchitis pathophysiology (Blue Bloaters)

Answer 4

Hypertrophy and hyperplasia of mucus secreting glands in bronchial tree, broncial wall inflammation and mucosal oedema. Ulcerations may cause metaplasia of columnar epithelium -> squamous epithelium. Capillary bed intact; body responds to increased obstruction by decreasing ventilation and increasing cardiac output. Poor ventilation to perfusion mismatch -> hypoxia (blue). Obstruction causes increasing residual lung volume (bloating)

Question 5

Emphysematous pathophysiology (pink puffers)

Answer 5

Destruction of lung tissue distal to terminal bronchioles -> loss of elastic recoil. This usually is what allows airways to remain open following expiration, so causes air trapping. Also causes damage to capillary bed -> Inability to oxygenate -> Hyperventilation (puffing)

Question 6

Aetiology

Answer 6

Chronic inflammation of the airways; usually by smoking or occupational irritants
This causes the mucous gland hypertrophy, and increase in neutrophils, macrophages and lymphocytes in airways -> Increase in inflammatory mediators (recurrent cycle) -> Breakdown of lung tissue.

Question 7

Diagnostic tests

Answer 7

Spirometry, CXR:>6 ribs visible

Question 8

Treatment

Answer 8

Smoking cessation

1. SABA or SAMA
2. +LABA/LAMA
3. Inhaled glucocorticoid
4. LAMA + LABA + inhaled steroid
5. +long term 02 therapy

Question 9

Complications

Answer 9

Respiratory failure