Definitions & General Information

Question 1

What is COPD?

Answer 1

COPD is a common, preventable, treatable disease. With persistent respiratory symptoms & airflow limitation (FEV1/FVC<70%) that is due to airway/alveolar abnormalities.
Lung hyperinflation
Usually caused by smoking

Question 2

ACO-Asthma COPD Overlap

Answer 2

Persistent airflow obstruction with features of asthma
Post-bronchodilator airflow limitation that is NOT fully reversible. History of asthma & diagnosis of COPD. FEV1/FVC<0.7
Post bronchodilator increase in FEV1/FVC >12% & 400 mls

Question 3

What % of the population has COPD? (World wide)

Answer 3

11.7%

3rd most common cause of death world wide

Question 4

How many Canadians have COPD?

Answer 4

804000 - 55% female

It is more common than, CHF, MI & various cancers

Question 5

What % of Canadian’s die from COPD?

Answer 5

4.4% of people over 40

Question 6

What is the pathology of COPD?

Answer 6

1. Inflammation in the lower resp tract (neutrophil invasion, increase in macrophages, CD8 & T lymphocytes, cytokine mediators -leukotrien, interlukin 8 & tumor necrosis factor this is called “elevated proteinase activity”
2. Fibrosis- narrowing of small airways
3. Destruction of alveolar wall creates large air spaces and decreased elastic recoil
4. Increase in mucus due to inflammation/plasma exudates
5. Dynamic hyperinflation during exercise

Question 7

What are the two most common bacteria COPDers get?

Answer 7

H. Influenzae & P. Aeruginosa

Question 8

What does the bacteria cause?

Answer 8

increase in mucus that disrupts normal ciliary activity that creates epithelial injury and reduced clearance

Question 9

Why should COPDers be screened for atherosclerosis?

Answer 9

Due to a low FEV1 that increases the risk of MI

Question 10

Key points for Alpha-1 Antitrypsin Deficiency

Answer 10

1. 2 Z allels
2. Liver CA is 5x more common
3. Liver cirrhosis is more common
4. COPD diagnosed before 40
5. presents at emphysema

Question 11

What is Alpha-1 Antitrypsin?

Answer 11

An enzyme produced in the liver that inhibits neutrophil elastase, this leaves the lung exposed to enzymatic damage

Question 12

Why are female copders at an increase risk of osteoporosis?

Answer 12

-3 times higher
Because airflow obstruction causes reduced bone mineral density
- all COPDers should be tested for osteoporosis

Question 13

Why do COPDers have an increased risk of diabetes?

Answer 13

Inflammation increases insulin resistance

Question 14

Where is surfactant protein D secreted?

Answer 14

The peripheral lung tissue

Question 15

What % of COPDers have anemia?

Answer 15

15-30%

Question 16

What type of anemia?

Answer 16

Normochromic, normocytic

Question 17

What is Chronic Bronchitis?

Answer 17

Regular sputum production for 3 months+ in two consecutive years in absence of any other condition

Question 18

Why Spirometry?

Answer 18

It is the best standardized, most reproduceable & most objective measurement of airflow limitation
(Need three tests within 5% or 150 mls of each other)

Question 19

What is Chronic Respiratory Acidosis?

Answer 19

“CO2 retainer”

When patient cannot move sufficient air, CO2 builds up in the blood

Question 20

What % of CHF patients have COPD?

Answer 20

20-30%

Question 21

BNP (b-type natriuretic peptide)levels in CHF pts?

Answer 21

Will be higher in CHF