Chronic Obstructive Pulmonary Disorder

Question 1

What is Chronic Obstructive Pulmonary Disorder (COPD)?

Answer 1

Inflammation of the airways leading to reduced air-flow and difficulty breathing

Question 2

What are the main two types of COPD?

Answer 2

Chronic Bronchitis and Emphysema

Question 3

What is Chronic Bronchitis?

Answer 3

Increase mucus production + inflammation + narrowed bronchioles leads to chronic airway obstruction

Question 4

Why is a barrel chest symptoms a symptom of chronic bronchitis?

Answer 4

Airway obstruction leads to trapped air, so an increase in total lung capacity which presents as a barrel chest

Question 5

What is the pathophysiology of emphysema?

Answer 5

Normal elasticity of the airway is lost, leading to permanent abnormal enlargement of the alveoli

Question 6

What are the consequences of emphysema?

Answer 6

1. Decreased surface area for gas diffusion (can cause hypoxemia or hypercapnia)
2. Loss of lung recoil making it harder to expel air

Question 7

What are the causes of COPD?

Answer 7

Mainly smoking, industrial/atmospheric pollutants

Question 8

What defiency can lead to increase risk of developing COPD?

Answer 8

Alpha 1 antitrypsin deficiency, as not enough is made in the liver

Question 9

What are the symptoms of COPD?

Answer 9

Progression SOB, reduced exercise intolerance, persistent cough, sputum production, wheeze, weight lost/peripheral muscle weakness

Question 10

Systemic features of COPD?

Answer 10

Cachexia, osteoporosis, skeletal muscle wasting, loss of appetite

Question 11

What is the time frame for a diagnosis of COPD ?

Answer 11

Cough and overproduction of mucous for 3 months each year, for 2 consecutive years

Question 12

What other signs of COPD are there when carrying out respiratory examination?

Answer 12

Cardiac apex not palpable, dullness on percussion, raised JVP, use of accessory muscles, reduced cricosternal distance

Question 13

COPD presentation in chronic bronchitis?

Answer 13

BLUE BLOATER - bluish lips (low levels of oxygen/hypercapnia + VQ mismatch)

Question 14

Why can chronic bronchitis lead to pulmonary hypertension?

Answer 14

Vasoconstriction occurs to get blood to healthy alveoli (as some are dying/dead), so increase in pulmonary vascular pressure

Question 15

What are the MAIN symptoms of chronic bronchitis?

Answer 15

Productive cough, sputum production, cyanosis, wheezing, prolonged expiration

Question 16

COPD presentation in emphysema?

Answer 16

PINK PUFFER - reddish complexion, puffing (hyperventilation), thin pursed lips

Question 17

What are the clinical symptoms of emphysema?

Answer 17

VQ mismatch, ABGs show less hypoxemia than blue bloater, tachypnoea, difficulty breathing

Question 18

What investigations can we use to diagnose COPD?

Answer 18

Spirometry (reduction in PEFR, FEV1, FVC), chest x-ray, FBC, BMI calculated, sputum culture,
Normal Spirometry: FEV1, >80% & FVC, >80%

Question 19

What are the treatments for COPD?

Answer 19

Lifestyle advice (quit smoking, exercise), supplemental oxygen, medication (bronchodilators, inhaled steroids)

Question 20

What is cor pulmonale?

Answer 20

Pulmonary hypertension leads to enlargement of right-side of heart, resulting in right-sided heart failure

Question 21

What is cor pulmonale?

Answer 21

Pulmonary hypertension leads to enlargement of right-side of heart, resulting in right-sided heart failure