Pathology COPD

Question 1

After how many subdivisions of bronchi does the respiratory zone begin?

Answer 1

1. Main bronchi
2. Lobar bronchi
3. Segmental bronchi
   Then bronchioles, acinus, respiratory zone.

Question 2

Name the primary genetic predisposing factor for COPD. What is its mechanism?

Answer 2

Alpha-1-anti-trypsin deficiency.

Alpha-1 is a protease inhibitor. A surfeit of protease will accelerate elastin breakdown.

Question 3

What is the historic diagnosis of chronic bronchitis?

Answer 3

Chronic productive cough on most days for 3 months during each of two consecutive years, when other causes are excluded.

Question 4

A pathological change in bronchial epithelium in bronchitis is squamous metaplasia. Of what does this consist?

Answer 4

A change from epithelial to squamous cells, a benign, non-cancerous change.

Question 5

What are some physical signs of COPD? Name three.

Answer 5

1. Lips pursed expiration.
2. Barrelling of chest.
3. Intracostal dimples.
4. Paradoxical costal margin.

Question 6

Audible signs of COPD?

Answer 6

1. Wheeze polyphonic expiration.
2. Inspirational crackles.
3. Heart sounds in epigastrium.

Question 7

What indications of COPD occur on a radiograph? Name three.

Answer 7

Diaphragm below anterior Rib VI
Lack of streakiness indicating tissue damage in lungs
Heart inferior to normal position.
Flattening of diaphragm.

Question 8

What are the best investigations to determine a diagnosis of COPD?

Answer 8

CXR

Spirometry

Question 9

What are the most important investigations of spirometry? How do they determine diagnosis of COPD?

Answer 9

FVC Forced Vital Capacity (functional lung volume, with only residual left).
FEV1 Forced Expiration Volume in one second (COPD makes this much less than normal)

If FEV1 is under 70% of FVC, COPD likely.

Question 10

What are acronyms FVC and FEV1 srand for spirometry?

Answer 10

FVC: forced vital capacity
FEV1: forced expiratory volume (after 1 second)

Question 11

What are the two disease components of COPD?

Answer 11

Bronchitis and Emphysema

Question 12

Describe the pathology of bronchitis.

Answer 12

Chronic inflammation of bronchi, smooth muscle contraction, hypertrophy and hyperplasia of mucus-secreting glands, mucosal oedema. Epithelial ulceration and squamous metaplasia.

Question 13

Describe the pathophysiology of emphysema.

Answer 13

Destruction of lung tissue in ventilation zone. Loss of elastic recoil. FEV limitation, air trapping.

Question 14

Describe: ‘pink puffers’ and ‘blue bloaters’

Answer 14

PP: COPD predominant emphysema
BB: predominant chronic bronchitis