COPD Questions

Question 1

Definition

Answer 1

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease characterized by airflow limitation that is not fully reversible. It includes emphysema, chronic bronchitis, and bronchiolitis.

Question 2

Pathophysiology

Answer 2

Chronic inflammation damages the airways, alveoli, and pulmonary vasculature. Increased goblet cells and mucus-secreting glands lead to airway obstruction. Elastin breakdown results in alveolar damage (emphysema).

Question 3

Epidemiology

Answer 3

COPD is the third leading cause of death worldwide. Prevalence is 15.7% in men and 9.93% in women globally. Tobacco smoke is the leading cause, with significant occupational and environmental contributions.

Question 4

History

Answer 4

History of smoking, progressive dyspnea, chronic cough, and sputum production. Symptoms worsen with time. History of occupational exposure or air pollution may also be relevant.

Question 5

Examination

Answer 5

Barrel chest, reduced breath sounds, wheezing, and use of accessory muscles during breathing. Cyanosis and signs of right-sided heart failure (cor pulmonale) may appear in advanced disease.

Question 6

Investigations - Bedside

Answer 6

Spirometry is the diagnostic gold standard, showing FEV1/FVC ratio <0.7 post-bronchodilator. Pulse oximetry screens for hypoxia.

Question 7

Investigations - Bloods

Answer 7

Full blood count (FBC) to identify anemia or polycythemia. Blood eosinophil count predicts corticosteroid responsiveness.

Question 8

Investigations - Imaging

Answer 8

Chest X-rays show hyperinflation and flattened diaphragm. High-resolution CT is more sensitive for diagnosing emphysema and other complications.

Question 9

Investigations - Special Tests

Answer 9

Diffusing capacity of the lung for carbon monoxide (DLCO) and arterial blood gases (ABG) assess disease severity and oxygenation. Exercise testing evaluates functional capacity.

Question 10

Management - Conservative

Answer 10

Smoking cessation, influenza and pneumococcal vaccination, and pulmonary rehabilitation.

Question 11

Management - Medical

Answer 11

Bronchodilators (short-acting and long-acting), inhaled corticosteroids (ICS), and phosphodiesterase-4 inhibitors. Antibiotics for acute exacerbations. Oxygen therapy for severe disease.

Question 12

Management - Surgical

Answer 12

Lung volume reduction surgery (LVRS), bullectomy, or lung transplantation in selected cases of severe emphysema.

Question 13

Risks of Treatments

Answer 13

Procedures carry risks of infection, pneumothorax, and cardiovascular complications. Long-term ICS use may cause pneumonia.

Question 14

Benefits of Treatments

Answer 14

Improves symptoms, reduces exacerbations and hospitalizations, and enhances quality of life. Long-term oxygen therapy improves survival in severe cases.

Question 15

Medical and Laboratory Sciences

Answer 15

Spirometry, DLCO testing, and biomarker analysis (e.g., eosinophil counts) support diagnosis and treatment stratification.

Question 16

Prognosis

Answer 16

Prognosis varies by severity. Median survival in severe COPD is 5 years. Exacerbations significantly worsen outcomes.

Question 17

Complications

Answer 17

Exacerbations, respiratory failure, pulmonary hypertension, and cor pulmonale. Comorbid conditions include cardiovascular disease, osteoporosis, and depression.

Question 18

Differentials

Answer 18

Asthma, bronchiectasis, lung cancer, congestive heart failure, and tuberculosis. Spirometry and imaging help differentiate these conditions.

Question 19

Cheat Sheet/Buzz Words

Answer 19

Buzzwords: Progressive dyspnea, chronic cough, FEV1/FVC ratio <0.7, barrel chest, hyperinflation, long-acting bronchodilators, smoking cessation.