COPD

Question 1

Management

Answer 1

Vaccinations
Stop smoking
Pulmonary rehab
Steroid inhalers

Question 2

Which vaccinations would you recommend?

Answer 2

Pneumococcal

Flu

Question 3

Pathophysiology

Answer 3

Shit from cigarette smoke activate macrophages
Neutrophil activation
Antiprotease produced more
Antioxidants produced less

Drives increased mucus production and epithelial cell injury

Leads to emphysema and chronic bronchitis

Question 4

Where do long acting beta agonists work?

Answer 4

B2 receptor on muscle

Note: there is no direct sympathetic activation of the lungs, it’s indirect via adrenaline

Question 5

Where do long acting muscarinic antagonists work?

Answer 5

Acetylcholine normally induces constriction, so blocks this and ALSO blocks mucus production

Question 6

Name some Non-adrenergic, non-cholinergic

Answer 6

Substance P

Vasal intestinal peptide

Question 7

How do steroids work?

Answer 7

Interfere with activation of neutrophils.

Question 8

First line prescription

Answer 8

1x Salbutamol, 100mcg/puff inhaler

Inhale 2 puffs as needed, maximum 2 puffs four times per day

Question 9

Second line?

Answer 9

If short acting doesn’t work, you try LABA or LAMA

Question 10

When do you include ICS steroid as second line and what do you include it with?

Answer 10

If they are asthmatic, with LABA

Question 11

What is the end stage support?

Answer 11

Triple therapy

Question 12

What if someone came back with hypertension?

Answer 12

Send them for ABPM

Question 13

What is COPD?

Answer 13

An irreversible obstructive lung disease

Question 14

What two conditions form COPD?

Answer 14

Chronic bronchitis

Emphysema

Question 15

What is chronic bronchitis?

Answer 15

This is where inflammation of the bronchial walls causes hypertrophy and hyperplasia of the mucosa of the bronchioles, including goblet cells. Therefore you also get increased mucus production and hence the productive cough.

Question 16

Give some signs of chronic bronchitis

Answer 16

Signs: 
Hypoxemia 
Hypercapnia 
Wheeze (narrowing of vessel walls) 
Productive cough
Crackles
Rales

Question 17

What PFTs are seen in COPD?

Answer 17

Air can't get OUT therefore: 
Low FEV1
Low FVC
Low ratio of FEV1 to FVC
Residual volume is increased

Question 18

What are the three types of emphysema?

Answer 18

Centriacinar / centrilobular emphysema
Panacinar paraseptal
Paraseptal emphysema

Question 19

Where do you get centriacinar emphysema and which group of patients typically get this?

Answer 19

Affects proximal alveoli of an acinus (cluster of alveoli)

Mainly in upper lobes of the lungs, in smokers

Question 20

Where do you get panacinar emphysema and which group of patients typically get this?

Answer 20

Affects all aspects of acinus, usually in lower lobes and associated with alpha-1 antitripsin deficiency

Question 21

What is paraseptal emphysema?

Answer 21

Affects distal alveoli of acinus, especially in lung peripheries on between lobes (hence interseptal)

Question 22

What is emphysema?

Answer 22

This is where the elasticity of the alveoli breaks down as a result of neutrophils releasing elastase. This leads to chronic widening of the alveoli

Question 23

What is the chest shape of someone with emphysema, and why?

Answer 23

Barrel chest due to hyperinflation

Question 24

What symptoms would someone with emphysema present with?

Answer 24

Shortness of breath

Question 25

When can you diagnose chronic bronchitis?

Answer 25

Based on a productive cough that lasts for at least 3 months, and over a period of 2 or more years.

Question 26

Do you get bronchiectasis or atelectasis in COPD?

Answer 26

Atelectasis - alveolar collapse

Note: bronchiectasis is seen in chronic infection/inflammation of the lungs, resulting in widening of the bronchi