PHARM - Drugs Affecting the Respiratory System: COPD - Week 7

Question 1

Define COPD.

Answer 1

Chronic obstructive pulmonary disease - a group of disorders characterised by airway inflammation and airflow limitation that is not fully reversible.

Question 2

Are COPDs preventable and/or curable?

Answer 2

Almost completely preventable but completely incurable.

Question 3

Compare death rates for coronary heart disease, stroke, CVDs, and other causes compared to COPDs.

Answer 3

All are on the decline for the past 50 years except COPD which is on a sharp incline.

Question 4

What population is at the higher risk of COPDs? Name 6 additional risk factors for the development of COPDs.

Answer 4

Ageing populations

• cigarette smoke
• occupational dust/chemicals
• environmental tobacco smoke
• indoor/outdoor air polution
• genetics
• infections

Question 5

What is FEV1 and what happens to it with age?

Answer 5

It is the amount of air you can forcefully exhale in one second. It naturally declines with age.

Question 6

How does smoking and quitting smoking affect FEV1? Is there any known cure for this effect?

Answer 6

There is a more rapid decline in FEV1 when smoking. Quitting smoking will slow down its progression, but it will not return to normal age-matched levels.
There is no known cure to restore normal levels.

Question 7

Are COPDs acute or progressive?

Answer 7

Progressive

Question 8

What kind of response do lungs have with COPDs and to what?

Answer 8

Inflammatory response of the lungs to noxious particles and gas

Question 9

What is the major risk factor for COPDs and what percentage of cases is it responsible for?

Answer 9

Smoking, which is responsible for 80-90% of cases

Question 10

What three components form the diagnosis of COPD?

Answer 10

Spirometry
Clinical symptom assessment
Exacerbation history

Question 11

After a noxious agent causes inflammation in the lungs, describe four outcomes of this and what it leads to.

Answer 11

Airway inflammation
Airway remodelling
Loss of alveolar attachments
Decrease of elastic recoil
Collectively this causes airflow limitations

Question 12

What three diseases are encompassed by COPDs? Do most patients have 1, 2 or 3 of these diseases?

Answer 12

Chronic obstructive bronchiolitis
Chronic bronchitis
Emphysema
Most patients have all three

Question 13

Briefly describe chronic obstructive bronchiolitis (2).

Answer 13

Fibrosis and obstruction of small airways

Question 14

Briefly describe chronic bronchitis (2).

Answer 14

Mucus plugging and coughing

Question 15

Briefly describe emphysema (4).

Answer 15

Enlargement of airspaces
Destruction of lung parenchyma
Loss of lung elasticity
Closure of small airways

Question 16

Consider the small airways of someone with COPD. What is the diameter like during inspiration and expiration? What two things does this eventually result in (4)

Answer 16

Inspiration - thickened airway with a far smaller diameter compared to normal
Expiration - airway closure
This leads to air trapping and hyperinflation.
Eventually this causes dyspnoea and decreased exercise tolerance.

Question 17

What immune cells (4) and what enzyme is responsible for the cellular mechanisms of COPDs? What do they cause?

Answer 17

Macrophages, T cells, neutrophils, and monocytes, as well as proteases. Cause mucus hypersecretion.

Question 18

What three factors can exacerbate COPDs?

Answer 18

Bacteria
Viruses
Pollutants

Question 19

What are the three aims of treating COPDs?

Answer 19

Symptom relief
Improvement of exercise tolerance
Prevention or treatment of exacerbation/complications

Question 20

What are 5 non-pharmacological options for treating COPDs?

Answer 20

Stop smoking
Manage/minimise impact of co-morbidities
Pulmonary rehabilitation
Lung volume reduction surgery
Oxygen therapy

Question 21

What is the addicting component of smoking?

Answer 21

Nicotine

Question 22

What effect can nicotine have on the body and why will some people continue smoking because of this?

Answer 22

Major appetite suppressant

Many will continue to smoke to control weight

Question 23

Name 5 possible pharmacological therapies for COPDs.

Answer 23

Bronchodilators
Glucocorticoids
Methylxanthines
Antibiotics (if infected) 
Vaccines (pneumococcal/influenza)

Question 24

Name 2 adverse effects of using bronchodilators.

Answer 24

Muscle tremors

Tachycardia/palpations

Question 25

How are glucocorticoids administered to treat COPDs?

Answer 25

Inhaled

Question 26

Do clucocorticoids affect the progression of disease?

Answer 26

No

Question 27

What are glucocorticoids used to treat COPDs associated with?

Answer 27

Increased risk of pneumonia.

Question 28

When are methylxanthines used?

Answer 28

Severe COPD

Question 29

Can glucocorticoids be used chronically or short-term?

Answer 29

Short term only, chronic use should be avoided

Question 30

What are 2 limitations of glucocorticoids?

Answer 30

Resistance

Unfavourable benefit/risk ratio

Question 31

List the treatment options that have a significant effect on COPD progression.

Answer 31

None

Question 32

What is the mainstay of COPD treatment?

Answer 32

Long-acting bronchodilators

Question 33

Differentiate between COPD and athsma in terms of causes.

Answer 33

Athsma is caused by an allergen

COPDs are caused by noxious agents like cigarette smoke

Question 34

Differentiate between COPD and athsma in terms of immune cells involved (3 each).

Answer 34

Athsma involve mast cells, eosinophils, and CD4+ cells

COPDs involve macrophages, CD8+ cells, and neutrophils

Question 35

Differentiate between COPD and athsma in terms of what happens to the lungs.

Answer 35

Athsma results in bronchoconstriction and AHR

COPDs involve small airway narrowing and alveolar destruction

Question 36

Differentiate between COPD and athsma in terms of reversibility.

Answer 36

Athsma is reversible

COPDs are irreversible