COPD

Question 1

What pathogens are COPD patients predisposed to?

Answer 1

Moraxella cattharalis
Haemophilus influenza

Question 2

How does smoking lead to emphysema?

Answer 2

Macrophages and neutrophils try to phagocytose the irritants and the neutrophils release proteases which break down elastase reducing lung elasticity

Question 3

How does alpha1-antitrypsin deficiency lead to COPD?

Answer 3

Autosomal dominant disorder that prevents the breakdown of elastase.

Question 4

Centri-acinar emphysema?

Answer 4

Decreased surface area in proximal airways

Question 5

Pan-acinar emphysema?

Answer 5

Distal part of airways

Question 6

Distal acinar and paraseptal emphysema?

Answer 6

Close to pleura, can cause pneumothorax

Question 7

What can hypoxaemic vasoconstriction lead to?

Answer 7

Pulmonary hypertension, r. ventricular hypertrophy, cor pulmonale

Question 8

When is supplemental oxygen needed in COPD?

Answer 8

If sats are below 88% or partial pressure of oxygen is below 55mmHg

If heart failure/ increased haematocrit:

sats < 90% or PO2 below 60mmHg

Question 9

Why should you supply oxygen at 88-92% and not 100%?

Answer 9

To avoid deppressing hypoxic drive

Question 10

What bronchodilators are used in patients with mild or intermittent exacerbations?

Answer 10

SAMA (ipratropium) and a SABA (salbutamol)

Question 11

What bronchodilators are used in more moderate to severe COPD?

Answer 11

LAMA and a LABA

Question 12

What drug therapy is used in severe COPD?

Answer 12

LABA and ICS