COPD (chronic obstructive pulmonary disease)

Question 1

Definition of COPD

Answer 1

Poorly reversible airflow limitation that is usually progressive and associated with a persistent inflammatory response of the lungs.

Chronic bronchitis and emphysema

Question 2

Aetiology

Answer 2

Cigarette smoking is a major cause (90% of cases occur in cigarette smokers in developed countries)

Long-term exposure to toxic particles and gases

Cooking in poorly ventilated places

climate and air pollution are lesser causes

Urbanisation, social class and occupation may all also play a roll

Question 3

Symptoms

Answer 3

productive cough with white or clear sputum

Wheeze and breathlessness that’s persistent and progressive

Symptoms can be worsened by the cold or damp weather and atmospheric pollution

Colds seem to ‘settle on the chest’

Frequent infective exacerbations occur with purulent sputum production

Advanced disease:
– breathless at rest, so breathlessness is severe
– pulmonary hypertension
– chest expansion is poor due to lungs being hyperinflated
– pursed lip breathing used to help prevent airway collapse
– osteoporosis can be caused
– depression
– weight loss
– reduced muscle mass with general weakness

Signs:
- mild COPD- may be no signs and just a wheeze in the chest
- severe disease:
– accessory muscle use when breathing
– pt may suffer with central cyanosis

Development of respiratory failure in the later stages of COPD

Question 4

Chronic bronchitis

Answer 4

Airflow narrowing leading to airflow limitation
– as a result of hypertrophy and hyperplasia of mucus-secreting glands of the bronchial tree
– bronchial wall inflammation as well and mucosal oedema
– cigarette smoke causes mucus gland hypertrophy

Question 5

Emphysema

Answer 5

Destruction of lung tissue distal to the terminal bronchioles.
Emphysematous changes lead to loss of elastic recoil, which means may not open as much during inspiration and expiration.

Also, the inner walls of the sacs in the lungs weaken and rupture, this reduces the surface area of the lungs, and in turn the oxygen that reaches the bloodstream

3 mechanisms suggested to the reason for airflow limitations in small airways:
– loss of elasticity
– inflammation and scarring
– mucus secretion

Question 6

Epidemiology

Answer 6

The socioeconomic burden of COPD is huge

Causes approx 18 million missed work days in the UK (7% of all work days missed in the UK)

COPD hospital admissions have been falling steadily over the last 30 years

Question 6

Epidemiology

Answer 6

The socioeconomic burden of COPD is huge

Causes approx 18 million missed work days in the UK (7% of all work days missed in the UK)

COPD hospital admissions have been falling steadily over the last 30 years