COPD

Question 1

Definition of COPD

Answer 1

A chronic, progressive respiratory disease characterized by airflow limitation.

Question 2

Causes of COPD

Answer 2

Long-term exposure to irritants such as tobacco smoke, air pollution, chemical fumes, and dust.

Question 3

Main Types of COPD

Answer 3

Chronic bronchitis and emphysema.

Question 4

Symptoms of COPD

Answer 4

Chronic cough, sputum production, shortness of breath (dyspnea), wheezing, and chest tightness.

Question 5

Pathophysiology of COPD

Answer 5

Chronic inflammation leads to structural changes in the airways, destruction of alveoli, and mucus hypersecretion.

Question 6

Chronic Bronchitis

Answer 6

Inflammation of the bronchial tubes, leading to excessive mucus production and chronic cough.

Question 7

Emphysema

Answer 7

Damage to alveoli, leading to reduced gas exchange and air trapping.

Question 8

Risk Factors for COPD

Answer 8

Smoking, exposure to secondhand smoke, occupational exposures, and genetic factors (e.g., alpha-1 antitrypsin deficiency).

Question 9

Alpha-1 Antitrypsin Deficiency

Answer 9

A genetic condition that can cause COPD by reducing lung protection from proteolytic enzymes.

Question 10

Diagnosis of COPD

Answer 10

Based on spirometry, showing reduced FEV1/FVC ratio (< 0.7), along with clinical symptoms.

Question 11

COPD Stages (GOLD Classification)

Answer 11

Based on FEV1: mild (≥80%), moderate (50-79%), severe (30-49%), and very severe (<30%).

Question 12

Treatment of COPD

Answer 12

Includes smoking cessation, bronchodilators, corticosteroids, oxygen therapy, and pulmonary rehabilitation.

Question 13

Bronchodilators

Answer 13

Medications that relax airway muscles, including beta-agonists (e.g., salbutamol) and anticholinergics (e.g., tiotropium).

Question 14

Corticosteroids in COPD

Answer 14

Used to reduce inflammation, especially in patients with frequent exacerbations (e.g., inhaled budesonide).

Question 15

Oxygen Therapy

Answer 15

Indicated in severe COPD with hypoxemia (PaO2 < 55 mmHg or SaO2 < 88%).

Question 16

Exacerbations of COPD

Answer 16

Acute worsening of symptoms, often triggered by infections or environmental pollutants.

Question 17

COPD and Respiratory Failure

Answer 17

Severe COPD can lead to hypoxic (type 1) or hypercapnic (type 2) respiratory failure.

Question 18

Complications of COPD

Answer 18

Pulmonary hypertension, right-sided heart failure (cor pulmonale), and frequent infections.

Question 19

Prevention of COPD Exacerbations

Answer 19

Vaccinations (influenza, pneumococcal), proper inhaler technique, and avoidance of triggers.

Question 20

COPD and Forensic Considerations

Answer 20

In post-mortem cases, signs of COPD like hyperinflated lungs, bullae, and airway remodeling are noted in forensic pathology.

Question 21

What are common obstructive lung diseases?

Answer 21

Chronic obstructive pulmonary disease (COPD), asthma, and bronchiectasis.

Question 22

What are the two major clinicopathologic manifestations of COPD?

Answer 22

Emphysema and chronic bronchitis.

Question 23

What is the WHO’s definition of COPD?

Answer 23

“A common, preventable and treatable disease characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities caused by exposure to noxious particles or gases.”

Question 24

What is the primary etiologic factor for COPD?

Answer 24

Cigarette smoking.

Question 25

What percentage of heavy smokers develop COPD?

Answer 25

35% to 50% of heavy smokers.

Question 26

Which groups are more susceptible to COPD?

Answer 26

Women and African Americans who smoke heavily.

Question 27

What additional risk factors are associated with COPD?

Answer 27

Poor lung development early in life, exposure to environmental pollutants, airway hyperresponsiveness, certain genetic polymorphisms.

Question 28

What are the two main types of emphysema that cause airflow obstruction?

Answer 28

Centriacinar and panacinar emphysema.

Question 29

Describe centriacinar emphysema.

Answer 29

Most common form, affecting central parts of acini in heavy smokers; upper lobes are more affected.

Question 30

Describe panacinar emphysema.

Answer 30

Associated with α1-antitrypsin deficiency; acini uniformly enlarged from respiratory bronchiole to terminal alveoli.

Question 31

What is distal acinar emphysema associated with?

Answer 31

Underlies many cases of spontaneous pneumothorax in young adults; proximal acinus is normal, distal part is involved.

Question 32

What characterizes irregular emphysema?

Answer 32

Irregularly involved acini associated with scarring; usually clinically insignificant.

Question 33

What are the mechanisms contributing to the development of emphysema?

Answer 33

Toxic injury from inhaled particles, protease-antiprotease imbalance, oxidative stress, infection.

Question 34

What role does toxic injury and inflammation play in emphysema?

Answer 34

Inhaled smoke damages respiratory epithelium, causing inflammation and parenchymal destruction.

Question 35

How does protease-antiprotease imbalance contribute to emphysema?

Answer 35

Deficiency of protective antiproteases leads to excessive connective tissue breakdown.

Question 36

What is oxidative stress and its role in emphysema?

Answer 36

Oxidants from tobacco smoke cause tissue damage and inflammation.

Question 37

How can infections affect emphysema?

Answer 37

Infections can exacerbate existing disease but do not initiate tissue destruction.

Question 38

What is the significance of α1-antitrypsin deficiency in emphysema?

Answer 38

Patients with genetic deficiency have enhanced emphysema risk, especially with smoking.

Question 39

What are the clinical features of advanced emphysema?

Answer 39

Barrel-chested, dyspneic, prolonged expiration, low diffusion capacity, relatively normal blood gas values, significant weight loss.

Question 40

What is chronic bronchitis defined as?

Answer 40

Persistent cough with sputum production for at least 3 months in 2 consecutive years.

Question 41

What are the primary factors contributing to chronic bronchitis?

Answer 41

Exposure to noxious inhaled substances like tobacco smoke and dust.

Question 42

What is mucus hypersecretion in chronic bronchitis?

Answer 42

Hypersecretion of mucus in large airways; associated with gland enlargement and increased goblet cells.

Question 43

How does smoking affect mucus secretion and airway function?

Answer 43

Smoking damages airway-lining cells, leading to inflammation and reduced ciliary action.

Question 44

What are the gross and microscopic features of chronic bronchitis?

Answer 44

Hyperemia, swelling, edema of mucous membranes, chronic inflammation, goblet cell hyperplasia, enlarged mucus-secreting glands.

Question 45

What is the Reid index, and how does it relate to chronic bronchitis?

Answer 45

The ratio of the thickness of the mucous gland layer to the thickness of the airway wall; increased in chronic bronchitis.

Question 46

What clinical features are associated with COPD?

Answer 46

Slowly increasing dyspnea, chronic cough, sputum production; often worsens with superimposed infections.

Question 47

What are the two extremes of COPD presentation?

Answer 47

"Pink puffers" (emphysema dominates) and "blue bloaters" (chronic bronchitis dominates).

Question 48

What are the treatment options for COPD?

Answer 48

Smoking cessation, oxygen therapy, long-acting bronchodilators, inhaled corticosteroids, antibiotics, surgery.

Question 49

What can lead to pulmonary hypertension in COPD patients?

Answer 49

Pulmonary hypertension, cor pulmonale, and heart failure.

Question 50

What is compensatory hyperinflation?

Answer 50

Dilation of alveoli in response to loss of lung substance elsewhere.

Question 51

What is obstructive overinflation?

Answer 51

Lung expands due to trapped air; caused by obstruction or congenital issues.

Question 52

What is bullous emphysema?

Answer 52

Large subpleural blebs or bullae; can rupture leading to pneumothorax.

Question 53

What is interstitial emphysema?

Answer 53

Air enters connective tissue stroma of the lung or mediastinum.