COPD and IPF

Question 1

Define COPD

Answer 1

• Common obstructive disease, that is characterised by persistent respiratory symptoms and airflow limitation, due to airway or alveolar abnormalities

Question 2

epidemiology of COPD

Answer 2

• Prevelance estimated 2-15% in industrialised countries
• more common in men
• becomes more common with age, usually after 40

Question 3

what is the most common risk factor for COPD

Answer 3

tobacco smoke

Question 4

People with COPD may have impaired mucociliary clearance. Describe what is meant by the “mucociliary escalator” and then outline how it may be impaired in people with COPD.

Answer 4

• Removes particles and pathogens by mechanical actions of cilia and cough – trapped in mucus layer and transported
• In COPD, patient suffers from mucus hypersecretion and reduced mucus transport

Question 5

Describe how cigarette smoke can lead to lung damage seen in people with COPD.

Answer 5

• Cigarette smoke causes hyperplasia and hypertrophy of mucus secreting glands found in the submucosa of the large cartilaginous airways
• Hyperplasia of the intraepithelial goblet cells occurs at the expense of ciliated cells in the lining epithelium. Regions of epithelium may undergo squamous metaplasia.
• Small airways become obstructed by intraluminal mucus plugs, mucosal oedema, smooth-muscle hypertrophy and peribranchial fibrosis. Secondary bacterial colonisation of retained products occurs.

Question 6

what are the 2 pathological processes in COPD

Answer 6

emphysema and chronic bronchitis

Question 7

describe emphysema in COPD

Answer 7

-alveolar destruction
- cigarette smoke induces the release of neutrophil elastase from neutrophils
- in COPD, there is an overwhelming volume of proteases produced, creating a protease-antiprotease imbalance
- alveolar attachments are destroyed
- airways collapse, resulting in airway obstruction
- lung compliance increases, air spaces form which rupture causing pneumothoraces

Question 8

describe the FRC changes in people with COPD

Answer 8

RV nad FRC are elevated in COPD
- FRC increases as Ventilation increases along with TLC - this indicates hyperventilation of lungs and air trapping

Question 9

what are the clinical features/ presentation of COPD

Answer 9

-progressive shortness of breath
- reduced exercise tolerance
- persistent cough
- chroinc sputum production
- weight loss
- peripheral muscle weakness and wasting

Question 10

what is the aim of COPD treatment

Answer 10

to treat symptoms and reduce exacerbations of disease

Question 11

describe pulmonary rehabilitation that may be used to treat COPD

Answer 11

Normally occurs in outpatient setting
courses usually last 6-12 weeks and aim to improve patient’s exercise tolerance