COPD

Question 1

COPD is progressively worsening, _______ airflow limitation

Answer 1

irreversible

Question 2

What are 3 types of COPD?

Answer 2

Chronic bronchitis
Emphysema
A1AT deficiency (alpha 1 antitrypsin)

Question 3

What are risk factors for COPD?

Answer 3

Cigarettes
Pollution
Genetics

Question 4

What type of inheritance is shown in A1AT deficiency?

Answer 4

Autosomal recessive

Question 5

In chronic bronchitis, there is h____ and h____ of mucous glands to protect against damage, commonly caused by cigarette use

Answer 5

Hypertrophy and hyperplasia

Question 6

In chronic bronchitis, chronic inflammation cells infiltrate the bronchi and bronchioles causing…

Answer 6

Luminal narrowing

Question 7

What 3 factors in chronic bronchitis all increase the risk of an infection and airway trapping?

Answer 7

Mucous hypersecretion
Ciliary dysfunction
Narrowed lumen

Question 8

What term was used to describe the stereotypical features of a chronic bronchitis patient

Answer 8

Blue bloater

Severe difficulty breathing causing decreased oxygen –> cyanosis, blueish tint.
Sometimes also overweight/obese.

Term not used today

Question 9

Chronic bronchitis is a productive cough (produces mucous) of more than _ months, occurring within a span of _ years

Answer 9

3 months
2 years

Question 10

How do patients with chronic bronchitis typically present?

Answer 10

Chronic productive cough (produce mucous)
Malaise
Chest pain
Abdominal pain

Question 11

What is emphysema?

Answer 11

Destruction of the elastin layer in alveoli ducts and sacs and respiratory bronchioles (final part after terminal bronchiole)

Question 12

Irritants like smoke from cigarettes triggers inflammatory reaction in alveolar walls and subsequently affects gas exchange. Name some inflammatory chemicals the immune cells release at the alveoli.

Answer 12

Leukotriene B4
IL-8
TNF-a

(Also elastases and collagenases present)

Question 13

What is the role of elastin in the alveolar sacs, ducts and respiratory bronchioles?

Answer 13

Keeps the walls open during expiration (Bernouli principle)

Question 14

What happens when there is less elastin (eg in emphysema) in the alveoli?

Answer 14

Walls close on expiration and air is trapped distal to blockage, causing large air sacs called bullae

Question 15

What type of emphysema only affects respiratory bronchioles and proximal alveoli/ upper lobes of lungs?

Answer 15

Centriacinar emphysema (more common type)

Thought that smoke doesn’t make it all the way to distal alveoli

Question 16

What is panacinar emphysema?

Answer 16

Air trapping across entire acinus (respiratory bronchioles, alveoli ducts and sacs)

Question 17

What condition is associated with panacinar emphysema?

Answer 17

Alpha-1 antitrypsin deficiency

Question 18

What do macrophages in the alveoli do in a healthy individual

Answer 18

Release proteases which helps to clear any debris

Question 19

What is the role of alpha-1 antitrypsin inhibitors?

Answer 19

Protease inhibitor so protects against unintended damage from the proteases released by the macrophages

Question 20

Where in the lungs does panacinar emphysema typically affect?

Answer 20

The lower lobes

Question 21

Where does paraseptal emphysema affect?

Answer 21

The distal alveoli near the periphery of the lobules near the interlobular septa

Question 22

What is a complication of paraseptal emphysema?

Answer 22

The ballooned out alveoli on lung surface may rupture and cause a pneumothorax

Question 23

Where is alpha 1 antitrypsin produced?

Answer 23

The liver

Question 24

When should A1AT deficiency be suspected?

Answer 24

In younger/middle age men with COPD symptoms but no smoking history

Question 25

What term was used to describe the stereotypical features of an emphysema patient?

Answer 25

Pink puffer Minimal cough Pursed lip breathing Muscle wasting (cachectic) Barrel chest Hyper-resonant percussion

Question 26

True or false: COPD patients often have either chronic bronchitis or emphysema?

Answer 26

False Often have a mix of both simultaneously

Question 27

What does 0 mean on the dyspnoea grading scale?

Answer 27

No trouble with breathing except with strenuous exercise

Question 28

What does 5 mean on the dyspnoea grading scale mean?

Answer 28

Too breathless to leave house / breathless with dressing

Question 29

How do you diagnose COPD?

Answer 29

Pulmonary function test: Increased fractional expired NO indicates lung damage FEV1:FVC is less than 0.7 indicates obstruction on PFT spirometry There is a less than 12% improvement in FEV1 with a bronchodilator in COPD (more than 12% in asthma) Genetic testing for A1AT deficiency ABG (type 2 resp failure) ECG Chest XR may show flattened diaphragm and bullae formation

Question 30

What happens to the diffusing capacity of CO across the lung in COPD?

Answer 30

It decreases (is normal in asthma)

Question 31

What is the initial stage in treating COPD?

Answer 31

Smoking cessation Influenza and pneumococcal vaccines

Question 32

What is the first medication for long term management of COPD?

Answer 32

SAB2A as required (salbutamol)

Question 33

What is added if just SABA is not enough for COPD?

Answer 33

LAB2A (eg salmeterol) and LAM3A (tiotropium)

Question 34

What is added to SABA, LAB2A and LAM3A for treating COPD?

Answer 34

ICS (inhaled corticosteroid)

Question 35

What is a complication of COPD?

Answer 35

Cor pulmonale (RHS heart failure due to increased portal hypertension)

Question 36

Long term oxygen is considered for severe COPD when oxygen is less than __% or less than __% with heart failure

Answer 36

88% 90% with heart failure

Question 37

Which 2 pathogens cause infections and exacerbate the COPD?

Answer 37

Streptococcus pneumoniae Haemophilus Influenzae