COPD

Question 1

What does COPD stand for

Answer 1

Chronic Obstructive Pulmonary Disease

Question 2

What is COPD

Answer 2

Mixed airway reversible obstruction and destructive lung disease

Question 3

What are the components of COPD

Answer 3

Asthma component - reversible

Bronchiectasis and emphysema component - non-reversible

Question 4

What effect does COPD have on ventilation and gas exchange

Answer 4

Damage to the large and smaller airways and damage to the alveoli so there is less ability to ventilate and have gas exchange

Question 5

What is bronchiectasis

Answer 5

Damage to the airway wall, dilation of the airway and increased mucous production

Question 6

Describe the aetiology of bronchiectasis

Answer 6

Increasing amount of mucous is produced by a disease process
This acts again in the same places causing changes in the airway wall causing scarred and thickened changes to the wall and damage to the muscle layers on the outside

Question 7

What is the effect of bronchiectasis

Answer 7

The airways become less reactive and responsive and it is difficult to clear mucous from the now widened airway

Question 8

What is bronchiectasis characterised by

Answer 8

A productive cough often with sputum which is green

Question 9

What is emphysema

Answer 9

Destruction of the alveolar sacs which will coalesce into larger spaces

Question 10

Describe a chest x-ray showing emphysema

Answer 10

Lack of black colour
Less air
More inflammatory change peripherally in lungs and therefore more whitening
Increase in cardiac size due to increased workload

Question 11

What are the symptoms of COPD

Answer 11

Cough
Increased mucous production
Fatigue
Shortness of breath
Dyspnoea
Chest discomfort

Question 12

What causes COPD (7)

Answer 12

Asthma
Smoking
Pollution
Age
Chemical exposure
AAT deficiency
Chronic bronchitis

Question 13

What are the complications of COPD (5)

Answer 13

Heart failure
Pneumonia
Depression
Frailty
Acute respiratory distress syndrome (ARDS)

Question 14

What percentage of patients in the US have smoking linked as a cause for COPD

Answer 14

90%

Question 15

How many people in the world have COPD

Answer 15

65M

Question 16

Which type of COPD is more common, chronic bronchitis or emphysema

Answer 16

Chronic bronchitis

Question 17

How are patients with COPD classified

Answer 17

According to their risk of having exacerbation and death

Question 18

Describe the meaning of each letter in COPD classification

Answer 18

A - less symptoms, low risk
B - More symptoms, low risk
C - Less symptoms, high risk
D - More symptoms, high risk

Question 19

Describe the numbers used in COPD classification

Answer 19

0 or 1 - Exacerbations not leading to hospitalisation
>2 - Exacerbations leading to hospitalisation
>or=1 - Exacerbations leading to hospitalisation

Question 20

How is COPD managed (6)

Answer 20

Smoking cessation
Long acting bronchodilator
Inhaled steroids if FEV<50%
Systemic steroids
Oxygen support
Pulmonary rehabilitation therapy

Question 21

Why can’t COPD be assessed in a similar way to asthma

Answer 21

Asthma is assessed based on severity

COPD is very specific to each patient

Question 22

What are the different types of COPD Exacerbations and how common are they

Answer 22

Non-infectious - 20%

Infectious - 80%

Question 23

What causes non-infectious COPD Exacerbations

Answer 23

Environmental factors

Non-compliance with medication

Question 24

What causes infectious COPD Exacerbations and how common are each types

Answer 24

Bacterial pathogens - 40-50%
Viral infection - 30-40%
Atypical bacteria - 5-10%

Question 25

What can COPD progress to

Answer 25

Type 1 or type 2 respiratory failure

Question 26

What causes type 1 respiratory failure

Answer 26

Happens due to problems in the alveoli

Question 27

What causes type 2 respiratory failure

Answer 27

Problems with ventilation

Question 28

Describe the aetiology of type 1 respiratory failure

Answer 28

Reduced surface area for gas exchange and thickening of the mucosal barrier due to diseases causing scarring of the alveolar surface

Question 29

How do patients with type 1 respiratory failure commonly act

Answer 29

Hyperventilate to increase O2 levels in the airways nearest to the alveolim increasing the concentration gradient allowing more oxygen to move into the blood
Patients tend to be pink to overcome hypoxia

Question 30

Describe the aetiology of type 2 respiratory failure

Answer 30

CO2 cannot be ventilated out of lungs due to narrowing or an exacerbation causing mucosal oedema
Causes O2 levels to fall and CO2 to rise which is mirrored in the blood

Question 31

How will a patient with type 2 respiratory failure look

Answer 31

Oedematous and hypoxic - blue

Question 32

When is someone classed as having a failure of oxygenation

Answer 32

When PaO2 <8.0kPa on air

Question 33

When is someone classed as having failure of ventilation

Answer 33

When PaCO2>6.7kPa

Question 34

What is the problem in using O2 on a patient with COPD and what should be done about this

Answer 34

It tends to reduce their need to breathe so patients with COPD should be monitored and their respiratory rate should be watched
Should be reassessed every 2-3 minutes

Question 35

What does an oxygen concentrator do

Answer 35

Tales O2 from the atmosphere and boosts its level within the inhaled gas so the patient can have a higher inspired concentration of O2 which will increase the concentration of O2 in the alveoli and therefore, in the blood

Question 36

When is home oxygen therapy effective

Answer 36

If used for 24 hours each day