COPD

Question 1

COPD is an umbrella term for..

Answer 1

Emphysema
Chronic bronchitis
Chronic Asthma

Question 2

Symptoms of Emphysema

Answer 2

Pink puffers 
difficulty breathing, well perfused 
barrel chest 
muscle wasting (thin) 
Pursed lips

Question 3

Symptoms of Bronchitis

Answer 3

Blue bloaters - severe dyspnoea and lack of exercise
cynosed
peripheral oedema
raised JVP (R side HF)

Question 4

Symptoms of both

Answer 4

Dyspnoea
Chronic cough

less common - wheezing
chest tightness
difficulty breathing

Question 5

Pathology of emphysema

Answer 5

Affects alveoli of the lunges

Alveoli are covered with elastic fibres allowing them to expand and recoil back pushing air out as we exhale

loss of elastic fibres - decrease in surface area of alveoli - collapsed alveoli

Air trapping within alveoli as we exhale because recoil mechanism is not working

Question 6

Chronic Bronchitis pathology

Answer 6

problems along airway tract specifically bronchioles. Normall bronchiole have smooth muscle and mucus however in bronchitis the muscle hypertrophys and contraction and mucus hypersecretion leads to difficulty breathing

Question 7

COPD risk factors

Answer 7

Smoking 
advanced age 
low socio-economic factors 
constant exposure to air pollution 
genetic factors - Alpha 1  
dvpmt abnormal lungs 
low birth weight 
recurrent infections 
cannabis smoking

Question 8

Pathophysiology of Emphysema

Answer 8

inflammatory response → elastic fibre breakdown and destruction of alveolar walls → loss of alveolar integrity → loss of alveolar recoil → air trapping

Question 9

What do Endogenous microphages do?

Answer 9

reside within alveolus and help to keep it clean and sterile

Question 10

How do toxic substances stimulate macrophages

Answer 10

produce proteases and cytokines

Question 11

What do Cytokines release? and how does it affect ventilation?

Answer 11

release and attract neutrophils from circulation to move into the area → neutrophils secrete elastase which specifically targets elastic tissues → loss of elastic fibres around the alveolus → loss of elastic recoil → decrease in ventilation

Question 12

How do Macropheges affect perfusion?

Answer 12

proteases are secreted by macrophages and neutrophils

lead to destruction of alveolar wall and capillary beds – decrease in perfusion

Question 13

what does air trapping mean? and how does it effect inspiratory volume

Answer 13

when you still have a lot of gas trapped in the alvelous after you exhale

increase in end IV - barrel chest

Question 14

what causes air trapping?

Answer 14

Loss of elasticity and destruction of alveolar wall

Question 15

V/Q mismatch is?

Answer 15

decrease in perfusion and decrease in ventilation

in blood decrease o2 and increase co2

Question 16

what does loss of elastic recoil lead to?

Answer 16

loss of alveolar integrity → work a lot harder to breathe in → dyspnoea & cachexia

Question 17

What hereditary condition is linked to COPD

Answer 17

Alpha 1 antitrypsin deficiency

if deficient cant defend against proteases - increase in proteases and decrease in anti-proteases resulting in net damage to lungs

Question 18

Chronic bronchitis inflammatory change leads to

Answer 18

mucociliary dysfunction

Question 19

Chronic bronchitis increased goblet cell secretion and numbers leads to

Answer 19

excessive mucus production

Question 20

Chronic bronchitis Where do we see bronchoconstriction and mucus hypersecretion (

Answer 20

in bronchioles and bronchi

Question 21

Chronic bronchitis mucus hypersecretion leads to

Answer 21

productive cough

Question 22

airway obstruction leads to

Answer 22

wheezing (usually expiration)

Question 23

Alveolar hypoxia is

Answer 23

oxygen not getting through to alveoli efficiently → V/Q mismatch → hypoxaemia and hypercapnia

Question 24

Chronic obstruction results in

Answer 24

less oxygen in and less CO2 out → decrease in O2 in blood and increase in CO2 in the blood

Question 25

COPD risk factors

Answer 25

``` Smoking (95%) Advanced age Low socio-economic factors Constant exposure to air pollution Genetic factors Alpha-1 antitrypsin deficiency Developmentally abnormal lungs - predisposes one to COPD Low birth weight Recurrent infections Cannabis smoking ```

Question 26

How is COPD assessed

Answer 26

severity of symptoms spirometry risk of exacerbation

Question 27

Observation of Emphysema

Answer 27

``` Prolonged expiratory phase → trying to push the air out of lungs PLB Over distension of lungs/barrel chest Use of accessory muscles Decrease in intensity of breath sounds ```

Question 28

what are you looking for in COPD in pulse oximetry

Answer 28

O2 saturation and hypoxaemia

Question 29

COPD ABGs you should check

Answer 29

pH | Typically in late stage COPD - respiratory acidosis

Question 30

CXR for COPD

Answer 30

Hyperinflation Lung larger than normal (greater expansion?) Heart may look longer than normal Pulmonary hypertension - prominent hila vascular shadow Flattened diaphragm - lower and flatter than usual Darker within the lung Lung shadow darker because a lot of trapped air Emphysema - bullae (pockets of air that can get up to 1 cm) Fluid build-up

Question 31

Criteria for diagnosis of COPD is spirometry

Answer 31

Decrease in FEV1 | Decrease in FEV1/ FVC <70%

Question 32

Auscultations for COPD

Answer 32

Emphysema Prolonged expiratory phase Decreased intensity of breath sounds Inspiratory + Expiratory Wheeze - Bronchospasm Coarse crackles - airway closure from mucus Prolonged forced expiration - to prevent airway walls collapsing during expiration Paradoxical quiet breath sounds

Question 33

management of COPD

Answer 33

``` Oxygen therapy surgical intervention pulmonary rehab steriods inhalers bronchodilators smoking cessation vaccine - prevent exacerbation of copd ```