Respiratory Lecture: Lower respiratory tract condition – COPD and Asthma a

Question 1

Chronic Obstructive Pulmonary Disease

Answer 1

common preventable and
treatable disease, is characterised by persistent respiratory symptoms and airflow
limitation that is due to airway and /or alveolar abnormalities usually caused by
significant exposure to noxious particles or gases…

Question 2

exacerbations

Answer 2

COPD may be punctuated by

periods of acute worsening of respiratory symptoms

Question 3

Pathological changes characteristic of COPD

Answer 3

found in the airways, lung parenchyma and
pulmonary vasculature.
▪Progressive airflow limitation associated with an abnormal inflammatory response of the
lungs usually associated with noxious gas or particles.

Question 4

▪Pathological changes include

Answer 4

inflammation, with increased numbers of specific
inflammatory cell types in different parts of the lung and structural changes resulting from
repeated injury and repair

Question 5

Noxious particles and gases

Answer 5

Inflammation of central
airways
Peripheral airway
Parenchymal destruction
Pulmonary

Question 6

Inflammation of central

airways

Answer 6

Inflammatory cells
(lymphocytes,
macrophages,
neutrophils)
• Inflammatory mediators

Question 7

Peripheral airway

Answer 7

remodelling

Question 8

Parenchymal destruction

Answer 8

Imbalance between
proteinase and
antiproteinase

Question 9

Pulmonary vascular

changes

Answer 9

Thick vessels
• Inflammatory cells
infiltrate
• Collagen disposition
• Destruction of
capillary bed

Question 10

Noxious particles and gases lead to

Answer 10

COPD Pathology/characteristics
• Mucus hypersecretion
• Cilia dysfunction
• Airflow limitation
• Hyperinflation of lungs
• Gas exchange abnormalities
• Pulmonary hypertension
• Cor pulmonale

Question 11

Main characteristics of COPD

Answer 11

▪Airflow limitation and air trapping leading to hyperinflation
▪Gas exchange abnormalities
▪Mucus hyper secretion
▪Pulmonary hypertension
▪Exacerbations
▪Systemic features

Question 12

COPD:

Symptoms

Answer 12

Breathlessness/dyspnoea
• Cough
• Sputum
• Hypoxia
• Fatigue
• Depression
• Chest pains
• Oedema
• Wheeze
• Weigh loss and anorexia
• Muscle weakness

Question 13

: causes and risk factors

Answer 13

Genes
Age and gender
Lung growth and
development
Exposure to particles
Asthma/bronchial
hyper-reactivity 
Chronic Bronchitis
Infections

Question 14

Genes

Answer 14

• Deficiency of Alpha 1 antitrypsin, which is an inhibitor of proteases
• Gene:MMP12 – related to declining lung function

Question 15

Age and gender

Answer 15

Age reflects a cumulative expose throughout life
• Men/Women prevalence almost equal.
• ? Women more susceptible to effects of tobacco smoke

Question 16

Lung growth and

developmen

Answer 16

Any factor that affects lung growth during gestation and childhood has
potential for increasing individuals risk of developing COPD
• Low birth weight

Question 17

Exposure to particles

Answer 17

Cigarette smoking (most common risk factor)
• Occupational exposure – dust, chemicals, fumes
• Indoor air pollution
• Outdoor air pollution

Question 18

Socioeconomic status

Answer 18

Poverty

Question 19

How does smoking damage lungs

Answer 19

Irritates bronchioles and alveolar sacs damaging the lining
▪Damages the elastin in the lungs
▪Damages and eventually destroys the cilia
▪Cause chronic inflammation
▪Can trigger asthma attacks

Question 20

COPD: Diagnosis

Answer 20

Full health history+ physical
examination + Spirometry
• General practice surgery, specialised laboratory
or by a specialist.
Other tests that may also be carried
out include:
• Gas transfer and lung volume tests
• Blood tests
• Sputum analysis
• Chest x-ray
• Computed tomography (CT) scan.
• ECG

Question 21

COPD
Management:
medical and
nursing

Answer 21

•Risk reduction
Smoking cessation
Occupational/environmental exposure
•Pharmacological therapy
•Management of Acute Exacerbations (change in baseline
•Surgical Management
▪Referral for pulmonary rehabilitation
-Patient education (breathing, vaccinations, smoking,
nutrition, management plans and when to seek
assistance, LTOT, Complications)
-Breathing exercises
-Activity pacing
-Self care
-Physical conditioning
-Oxygen therapy
-Nutritional therapy
-Coping measures

Question 22

Management of Acute Exacerbations (change in baseline)

Answer 22

Change in medication management (oral
corticosteroids)
ABG or VBG
Spirometry
Antibiotics
Controlled Oxygen Therapy !!! (Acute or LTOT) may
need BiPAP/CPAP if resp failure
Refer to pulmonary rehabilitation

Question 23

•Pharmacological therapy

Answer 23

Bronchodilators
Corticosteroids
Oxygen

Question 24

COPD: affect
on mental
health and
quality of life

Answer 24

Adjustment to illness
▪Impact on person and their family
▪ Stress incontinence
▪ Travel restrictions
▪Depression and anxiety
▪Use a quality of life questionnaire

Question 25

COPD: lifestyle advice

Answer 25

Quit smoking Physically active as
possible. Eat a healthy diet.
Adjustments to
lifestyle and home
environment to
ensure plenty of rest.
Hydration – mucus
Avoid smoky or dusty
environments. Join a support group

Question 26

COPD:
Nursing
practice

Answer 26

Varies across settings ▪Aim to minimise disease progression and
maximise quality of life. Examples ✓ Encourage patient motivation ✓ Assess insomnia, encourage sleep habits ✓ Monitor changes in mental health status ✓ Smoking cessation ✓ Education and support to family ✓ Influenza vaccination ✓ Monitor function capabilities, BMI, nutrition, airway
clearance techniques
✓ Education on exacerbations ✓ Assess use of inhaled medication

Question 27

COPD:
Nursing
practice

Answer 27

▪Key principles ✓ Encourage medication compliance ✓ Maximise functional ability ✓ Recognise signs/symptoms of
deterioration
✓ Education patient/family/carer ✓ Support activity modification ✓ Support symptom relief