COPD: Chronic Bronchitis

Question 1

Definition

Answer 1

Inflammation of the bronchial tubes
- defined by production cough for at least 3 months of the year for at least 2 consecutive years.

Question 2

Aetiology

Answer 2

Same as COPD = smoking
Exposure to air pollution (sulphur and nitrogen dioxide)
Exposure to dust or silica
Family history

Question 3

Pathophysiology

Answer 3

Ciliary dysfunction (e.g. from smoking) causes hypertrophy + hyperplasia of the bronchial mucinous glands (in the bronchi) + goblet cells (in the bronchioles) = leads to increased mucous production = lungs can’t empty properly = Since bronchioles are smaller, even a small amount of extra mucus can lead to obstruction =
increased air trapping = decreased FEV1 + FVC + high TLC
Smoking also makes the cilia shorten
People can also develop lung infections behind the mucus plugging (esp. during winter)

Question 4

Epidemiology

Answer 4

Occupation
Whites

Question 5

Symptoms

Answer 5

SOB
Productive cough
CO2 retention
- headache
- asterixis
- confusion
- drowsy

Question 6

Signs

Answer 6

Tachypnoea
Hypoxaemia
Hypercapnia
Cyanosis “blue bloaters”
Portal hypertension or Cor pulmonale = peripheral oedema, raised JVP, loud pulmonary sound
Wheeze on auscultation
Barrel chest = suggests hyperinflation + air trapping due to incomplete expiration
Crackles/rales on auscultation
- caused by popping open of small airways as the air moves through them

Question 7

Suspect COPD if…

Answer 7

Suspect COPD if over 35+ in long term smoker + one of:
- Chronic SOB
- Cough
- Sputum production
- Wheeze
- Frequent resp infections

Question 8

Complications

Answer 8

Cor pulmonale
Lung infections