WEEK 2: OBSTRUCTIVE LUNG DISEASE

Question 1

Describe the defining features and epidemiology of COPD

Answer 1

chronic obstruction of lung airflow, irreversible, SOB, cough, +/- sputum, caused by chronic inflammation

female, ↑age

Question 2

Describe the aetiological factors of COPD

Answer 2

• A1AT deficiency (earlier onset) => basal predominance emphysema
• SMOKING, induction of protease-antiprotease imbalance, stimulate chronic inflammation
• POLLUTANTS

Question 3

Describe the symptoms, signs and clinical patterns of COPD

Answer 3

35yr+, smoking Hx, cough wheeze SOB sputum, frequent chest infection, Wt loss fatigue swollen ankles

Question 4

Spirometry findings

Answer 4

OBSTRUCTIVE: ↓↓FEV1, ↓FVC, ↓FEV1:FVC <0.7

RESTRICTIVE: ↓FEV1, ↓FVC,

Question 5

Define the investigations used to diagnose COPD

Answer 5

• Spirometry
• PEFR
• CXR
• Gas transfer factor, ↓gas transfer = COPD likely V asthma
• HIGH RES. CT

Question 6

Emphysema: definition + main demographic

Answer 6

M > F (d/t smoking burden)

↑size of ACINAR airspaces distal to termainal bronchiole d/t dilatation / wall destruction w/o obvious fibrosis

Question 7

Emphysema subtypes

Answer 7

1. CENTRIACINAR: loss of middle acinar tissue, apical part of lobe/lungs
2. PANACINAR: lung areas in lower zone, A1AT def., heavy smoker, ↑loss of alveolar tiss
3. PERIACINAR: edge, acinus around pleura, BLEB FORMATION
4. SCAR EMPHYSEMA: Bulla, emphysematous spaces > 1cm, forms around scarring

Question 8

Chronic Bronchitis: definition (qualifying features); pathophys.

Answer 8

productive cough most days in at least consecutive months for 2or more consecutive years

d/t chronic irritation.
SIGNIFICANT MUCUS PROD AND RECRUITMENT + inflammation and fibrosis
complication: sputum mucopurulent

Question 9

Complication of COPD

Answer 9

1. hypoxaemia development
2. COR PULMONALE d/t vascular hypertension d/t chronic constriction. from hypoxia
3. 2º polycythaemia ↑RBC + viscocity = ** STROKE **
4. Respiratory Failure = Type 2 (O2 low CO2 high)

NO CLUBBING IN DIRECT COPD

Question 10

Respiratory Failure

Answer 10

decreased ventilation and perfusion, ↑deadspace

TYPE 1 RESP FAILURE: ↓PO2
TYPE 2 RESP FAILURE: ↓PO2 + ↑ PCO2 (vent. failure)

Hypercapnea => ACIDOTIC => HYPOXIC DRIve

*difficult. to monitor ventilatory failure if given too much O2

Question 11

Presentation of COPD 1º & 2º Care

Answer 11

1º = SEVERE EXACERBATION caused by INFECTION or trigger: change in air; collapsed lung; blood clots. Tx @ home or hospital?

2º = + flapping tremor, drowsiness

Question 12

Bronchial Asthma

Answer 12

Type 1 hypersensitivity: MC. REVERSIBLE

Question 13

Severe Bronchitis

Answer 13

• overweight & cyanotic
• ↑Hb
• Peripheral edema
• . wheezing + rhonchi

Question 14

Severe emphysema

Answer 14

• older and thin
• severe dyspnea
• . quiet. chest: recession and abdo distention
• hyperinflation with flattened diaphragm