L11 - COPD

Question 1

What is chronic obstructive pulmonary disease (COPD)?

Answer 1

A preventable and treatable disease characterised by progressive air-flow limitation, associated with abnormal inflammatory response

Question 2

What two factors lead to the airflow limitation seen in COPD?

Answer 2

Small airway disease (chronic bronchitis)
Parenchymal destruction (emphysema)

Question 3

Where does airflow limitation occur in COPD?

Answer 3

Small airways (bronchi and bronchioles <2mm)

Question 4

What occurs in parenchymal destruction (emphysema)?

Answer 4

Loss of alveolar attachments and decrease of elastic recoil

Question 5

What occurs in small airway disease (chronic bronchitis)?

Answer 5

Mucosal inflammation and fibrosis, mucus plugs

Question 6

What is emphysema?

Answer 6

Damage and destruction of alveolar sacs (parenchymal destruction)

Question 7

What is an informal name for someone with emphysema? Why is this?

Answer 7

Pink puffers - no cyanosis (blue colouration), hyperventilate to produce normal blood gases

Question 8

What manifestations can be seen in emphysema?

Answer 8

Tissue destruction, low elastic recoil in lungs, air becomes trapped causing an increased residual volume

Question 9

What is chronic bronchitis?

Answer 9

Chronic inflammatory condition that causes swelling and irritation of respiratory tract and build up of mucus (small airway disease)

Question 10

What is an informal name for someone with chronic bronchitis? Why is this?

Answer 10

Blue bloater - cyanosis (blue skin colouration) and peripheral oedema or overweight

Question 11

What manifestations can be seen in chronic bronchitis?

Answer 11

Chronic cough for at least 3 months per year for 2 years, thick mucus, decreased lung capacity

Question 12

What can chronic bronchitis result in?

Answer 12

Right heart failure and chronic pulmonary hypertension

Question 13

What is the main risk factor for developing COPD?

Answer 13

Smoking

Question 14

Give five risk factors for developing COPD

Answer 14

Smoking, exposure to particles (dust, work environment…), genetics, sex (female), age (usually 50-60)

Question 15

What is a major genetic cause of COPD? What is the likely prognosis for these people?

Answer 15

Alpha1-antitrypsin (AAT) deficiency

AAT deficient people develop COPD 20-30 years earlier, especially if they also smoke

Question 16

How does α1-antitrypsin deficiency cause destruction of the lung?

Answer 16

AAT is an anti-protease (suppresses proteases); AAT deficient people have more protease activity, resulting in more breakdown of tissues

Question 17

What is asthma–COPD overlap syndrome (ACOS)?

Answer 17

There is no clear definition, but it is a coupling of COPD and asthma, and has been used to explain why some patients respond well to corticosteroids

Question 18

What is the main cell involved in COPD?

Answer 18

Neutrophil

Question 19

What role does the neutrophil play in COPD?

Answer 19

It produces proteases (neutrophil elastase, MMP8, MMP9) that contribute to emphysema and mucus secretion, and reactive oxygen species that are involved in inflammation

Question 20

What technique is used to diagnose COPD? What does this involve?

Answer 20

Spirometry - patient breathes into spirometer to carry out lung function tests

Question 21

Give three of the main lung function test parameters

Answer 21

FEV1 - volume forcibly expired in 1st second
FVC - total volume forcibly expired
FEV1/FVC ratio
RV - volume of residual air after maximum exhalation
PEF - peak expiratory flow
TLC - total lung capacity at full inhalation
TV - tidal volume, volume in/exhaled at rest

Question 22

What lung function test parameters are decreased in COPD?

Answer 22

FEV1, FVC, PEF, TV

Question 23

What lung function test parameters are increased in COPD? Why is this?

Answer 23

RV and TLC as air is trapped in the lungs

Question 24

FEV1 declines naturally with age, more so in smokers. If someone were to stop smoking, what would happen to their FEV1?

Answer 24

It would still decline with age, but would be more gradual than if they had continues smoking

Question 25

What is the major cause of death in COPD patients?

Answer 25

Exacerbations - an acute event involving worsening of respiratory system

Question 26

What causes the majority of COPD exacerbations?

Answer 26

Respiratory tract infections caused by viruses or bacteria

Question 27

What are the main pathogens that cause exacerbations in COPD through respiratory infections?

Answer 27

Viruses - mainly rhinovirus, but also influenza etc.

Question 28

What treatment for COPD can slow the disease’s progression?

Answer 28

Stopping smoking, pharmacological treatments cant do this

Question 29

Give three ways that COPD can be treated

Answer 29

Stop smoking, vaccinations/antibiotics to prevent exacerbations, asthma treatments (corticosteroids, bronchodilators), surgical intervention