S8.2 COPD

Question 1

Define COPD

Answer 1

Chronic airway obstruction which is usually progressive, not fully reversible and does not change markedly over several months.
Encompasses emphysema and chronic bronchitis

Question 2

What is emphysema?

Answer 2

Destruction of terminal bronchioles causing loss of alveolar surface area, so reduced gas exchange.

Question 3

What are the features of emphysema?

Answer 3

Supporting tissue of small airways is destroyed, so they collapse upon expiration causing airway obstruction.
Loss of elastic tissue causes hyperinflation as lungs cannot resist rib cage expanding outwards.

Question 4

What is chronic bronchitis?

Answer 4

Chronic mucus hypersecretion due to inflammation in the large airways leading to proliferation of mucus-secreting cells in the respiratory epithelium.

Question 5

What are some causes of COPD?

Answer 5

Smoking (main)
>40 years old
Occupational exposure eg coal dust

Question 6

What are the symptoms of a COPD patient?

Answer 6

Productive cough with sputum

Progressive breathlessness

Question 7

What are the signs of a COPD patient?

Answer 7

Pursed lip breathing
Tachypnoea
Use of accessory muscles
Hyperinflation

Question 8

How is COPD diagnosed?

Answer 8

Symptoms eg cough, SoB
Spirometry: FEV1 < 80% of predicted, FEV1/FVC ratio < 70%. Obstructive pattern with no improvement on bronchodilaton
CXR

Question 9

What is the management of COPD?

Answer 9

Smoking cessation
Salbutamol
Antimuscarinics eg ipatropium bromide
Prednisolone