COPD

Question 1

What is COPD?

Answer 1

This is a multicomponent disease usually caused by the inhalation of noxious particles or gases e.g. smoking. This is non-atopic.

Question 2

What are the two conditions that predominantly make up COPD?

Answer 2

Emphysema and chronic bronchitis

Question 3

What are some of the characteristics of COPD?

Answer 3

Mucociliary dysfunction
Inflammation
Tissue damage
Exacerbations
Reduced lung function

Question 4

What are some of the symptoms of COPD?

Answer 4

Productive cough with white or clear sputum.
Wheeze
Breathlessness
Worsening quality of life

Question 5

What are some of the clinical signs of COPD?

Answer 5

Tachyponea
Use of accessory respiration
Hyperinflation
Low chest expansion
Resonant or hyperresonant on percussion
Cyanosis
Cor pulmonale

Question 6

What is the disease process of COPD?

Answer 6

1. Patient inhales cigarette smoke.
2. There is infilatration of alveolar macrophages which release - neutrophil chemotactic factors, IL-8 cytokines, mediators and O2 radicals.
3. Neutrophils then arrive at the site.
4. These release proteases.
5. These cause emphysema and chronic bronchitis.
6. This leads to progressive airflow limitation

Question 7

What is emphysema?

Answer 7

Alveolar wall destruction which leads to impaired gas exchange and a loss of bronchial support. This is irreversible.

Question 8

What is chronic bronchitis?

Answer 8

This is chronic mucous hyper secretion and neutrophil inflammation. It also has mucociliary dysfunction, an altered lung biome, smooth muscle spasm and hypertrophy. This is partially reversible.

Question 9

What tests can be done to confirm COPD?

Answer 9

Low forced expiratory ratio (<70%)
CT chowing bronchial wall thickening and air space enlargement.
This is mainly done by taking a history.

Question 10

What is a pink puffer?

Answer 10

These patients have HIGH alveolar ventilation, near normal PaO2 and normal or low PaCO2. They are breathless but not cyanosed and may progress into type 1 respiratory failure.

Question 11

What is a blue boater?

Answer 11

These patients have LOW alveolar ventialtion, low PaO2 and high PaCO2. They are cyanosed but not breathless and may go on to develop COR PUMLMONALE. There respiratory drive is insensitive to CO2 and they rely on hypoxic drive. These are the patients who we watch when giving O2.

Question 12

What is the chronic cascade in COPD patients?

Answer 12

Progressive fixed airflow obstruction.
Impaired alveolar exchange
Type 2 respiratory failure (high PaCO2 and low PaO2).
Pulmonary hypertension
Cor pulmonale
Death