Resp16 - COPD

Question 1

4 features of COPD

What is it?
Aetiology
Risk Factors
Calculating Pack Years
Irreversible

Answer 1

1. ) What is it? - Chronic Obstructive Pulmonary Disease
   - umbrella term to describe progressive lung diseases
   - patients usually have a mixture of the different lung disease
2. ) Aetiology - airflow limitation
   - small airway disease and parenchymal destruction
3. ) Risk Factors - smoking (90% in the UK) others:
   - air pollution, genetic (alpha-1 anti-trypsin), illicit drug use, biomass exposure
4. ) Calculating Pack Years
   - (cigarettes smoked per day/20) x no. of years smoking

5.) Irreversible - bronchodilator makes minimal difference

Question 2

2 different pathophysiologies of COPD

Answer 2

1. ) Chronic Bronchitis - small airway disease
   - airway inflammation/fibrosis –> reduced lumen size
   - leads to increased airway resistance
2. ) Emphysema - parenchymal destruction
   - alveolar breakdown –> reduced elastic recoil
   - can lead to a collapsed lung
   - increased TLC and RV due to air trapping

Question 3

4 symptoms of COPD

Answer 3

1. ) Persistent Dyspnoea - shortness of breath
   - progressively worse overtime and worse w/ exercise
2. ) Chronic Cough - may be intermittent or unproductive
   - often occurs with a recurrent wheeze
3. ) Chronic Sputum Production - any pattern
4. ) Recurrent LRTIs

Question 4

6 signs of COPD

Answer 4

1. ) Purse Lip Breathing - increases resistance to outflow on expiration to maintain intrathoracic airway pressure
   - small airways remain open for longer, giving more time for gas exchange and allowing more air to empty rather than trap
2. ) Barrel-Shaped Chest - hyperinflation of the lungs
   - more expanded due to loss of elastic recoil
   - X-ray shows a flattened diaphragm and increased AP diameter
3. ) Prolonged Expiratory Phase - take a longer time breathing out than usual
4. ) Wheeze on Auscultation - rare when clinically well
5. ) Cyanosis - rare, only in advanced cases
6. ) Cor Pulmonale - rare, only in advanced cases
   - hypoxic vasoconstriction –> pulmonary hypertension
   - leading to right sided heart failure
   - so can cause peripheral oedema

Question 5

4 investigations in COPD

Spirometry
Chest X-Ray
HRCT Scan
Alpha-1 Antitrypsin Test

Answer 5

1. ) Spirometry - shows obstructive patterns
   - more severe than asthma
   - reduced FEV1:FVC ratio (<70%), scalloping
   - not improved after using a bronchodilator
2. ) Chest X-Ray - exclude other diagnosis e.g. cancer
   - can suggest hyper-inflation
3. ) High Resolution CT (HRCT) Scan
   - assessment of degree of emphysema and if suspicious of bronchiectasis

4.) Alpha-1 Antitrypsin Blood Test - used in younger patients or atypical lower lobe emphysema

Question 6

4 features of exacerbations of COPD

Definition
Cause
Risk Factors x5
Treatment x3

Answer 6

1.) Definition - acute worsening of respiratory symptoms that results in additional therapy

2. ) Cause - mainly infections
   - bacteria, viruses, atypical organisms
   - if it’s bacteria, it can cause purulent sputum
   - also environmental factors and eosinophilic problems
3. ) Risk Factors
   - previous exacerbations, disease severity,
   - GORDs, pulmonary hypertension, respiratory failure
4. ) Treatment - depends on the cause
   - antibiotics (bacterial), steroids (eosinophilic), time (viral)

Question 7

Treaments for COPD

Medical/Surgical x6
Non-Pharmacological x3

Answer 7

1. ) Medical/Surgical - drugs, oxygen, surgery
   - bronchodilators, anti-inflammatories, mucolytics
   - oxygen therapy, non-invasive ventilation
   - lung volume reduction surgery, lung transplant

2.) Non-Pharmacological - pulmonary rehabilitation, refractory dyspnoea management, smoking cessation

Question 8

What is non-invasive ventilation?

Answer 8

1. ) A way to increase minute ventilation by increasing tidal volume
   - minute ventilation = tidal volume (TV) x respiratory rate
2. ) Increase in IPAP (inspiratory postive airway pressure) –> increase in TV –> increase in minute ventilation
   - increased ventilation –> decrease in CO2

3.) Mainly used to reduced CO2 levels