COPD

Question 1

What is chronic obstructive pulmonary disease (COPD)?

Answer 1

Long-term airflow obstruction

that is progressive

Question 2

What are the main types of COPD?

Answer 2

Emphysema

Chronic bronchitis

Question 3

What is emphysema?

Answer 3

Destruction of terminal bronchioles, respiratory bronchioles and alveolar walls

Question 4

How does emphysema affect the respiratory membrane?

Answer 4

Loss of surface area of respiratory membrane

Question 5

How does emphysema affect gas exchange in the alveoli?

Answer 5

Reduced gas exchange

Question 6

How does emphysema affect the air spaces in the lungs?

Answer 6

Large airspaces called bullae

Question 7

How does emphysema affect expiration?

Answer 7

Reduced expiration

Question 8

Why does emphysema cause reduced expiration?

Answer 8

Because loss of elastin in alveolar walls
don’t hold terminal bronchioles open
which collapse more easily during expiration

Question 9

How does emphysema affect the size of the lungs?

Answer 9

Hyper-inflation of lungs

Question 10

Why does emphysema cause hyper-inflation of lungs?

Answer 10

Less air expired in last breath
more air inspired on top of this

Loss of elastic recoil, lungs are more compliant, bigger increase in volume with same change in pleural pressure

Question 11

What is chronic bronchitis?

Answer 11

Chronic mucus hypersecretion

Question 12

What causes mucus hypersecretion with chronic bronchitis?

Answer 12

Inflammation in bronchi

gives mucous gland hyperplasia

Question 13

How does chronic bronchitis affect the airways?

Answer 13

Narrowing of airways

due to mucus

Question 14

What is a complication of the mucus hypersecretion in chronic bronchitis?

Answer 14

Traps bacteria

frequent respiratory infections

Question 15

What are the causes of COPD?

Answer 15

Mostly smoking

Alpha-1-antitrypsin deficiency

Question 16

What relative proportion of smokers get COPD?

Answer 16

Small proportion

Question 17

What are the symptoms of COPD?

Answer 17

Cough with sputum

Breathlessness on exertion

Question 18

What are the signs of COPD?

Answer 18

Purse lip breathing

Tachypnoea

Using accessory muscles

Barrel chest

Wheeze on auscultation

Cyanosis

High pCO2

Right-sided heart failure

Question 19

Why do patients with COPD show purse lip breathing?

Answer 19

Increases pressure in airways

to delay collapse of small bronchioles

Question 20

Why do patients with COPD use accessory muscles?

Answer 20

Because the lungs have less elastic recoil

so need to use internal intercostal muscles, abdominal muscles in order to reduce their volume

Question 21

Why are patients with COPD barrel-chested?

Answer 21

Hyper-inflation of lungs

Question 22

Why do patients with COPD have cyanosis, high pCO2?

Answer 22

Reduced gas exchange
gives hypoxaemia, cyanosis
and high pCO2

Question 23

Why do patients with COPD get right-sided heart failure?

Answer 23

In response to low pO2 in alveoli
get hypoxic pulmonary vasoconstriction
increases pulmonary vascular resistance
increases pressure in right side of heart

Question 24

How is COPD diagosed?

Answer 24

History of symptoms and signs

Spirometry

Chest X ray

High resolution CT

Arterial blood gases

Question 25

What would spirometry of a patient with COPD show?

Answer 25

Low FEV1 Low FEV1/FVC ratio How low they each are, correlating with severity

Question 26

What would a chest X-ray of a patient with COPD show?

Answer 26

Hyper-inflation of lungs

Question 27

What would a high resolution CT of a patient with COPD show?

Answer 27

Degree of terminal bronchiole, respiratory bronchiole and alveolar wall destruction

Question 28

What would arterial blood gases of a patient with COPD show?

Answer 28

Type 2 respiratory failure - low plasma pO2 - high plasma pCO2 Maybe respiratory acidosis -low plasma pH

Question 29

What is meant by stable COPD?

Answer 29

Patient has COPD but is able to manage at home

Question 30

How are patients with stable COPD managed?

Answer 30

Stop smoking Pulmonary rehabilitation Drugs Flu vaccinations Long term oxygen therapy Lung volume reduction

Question 31

How does FEV1 change with age?

Answer 31

After a certain age, decreases

Question 32

How does smoking affect the decrease in FEV1 with age?

Answer 32

Faster rate of decrease in FEV1

Question 33

Why are patients with stable COPD advised to stop smoking?

Answer 33

Reduces rate of decrease in FEV1 | regardless of how long have been smoking, regardless of age when stop smoking

Question 34

What is meant by deconditioning of a patient with COPD?

Answer 34

Exercise makes them feel breathless they avoid exercise their muscles weaken they got more breathless

Question 35

What is pulmonary rehabilitation?

Answer 35

Encourages patients with COPD to exercise, improve their diet to stop deconditioning

Question 36

What drugs are used to treat a patient with COPD?

Answer 36

B2 agonist Steroids Antimuscarinics Mucolytics Matylxanthines

Question 37

How do B2 agonists treat a patient with COPD?

Answer 37

Cause bronchodilation

Question 38

What are the side effects of using a B2 agonist to treat a patient with COPD?

Answer 38

Tachycardia, palpitations Tremors

Question 39

Why can B2 agonists cause tachycardia, palpitations?

Answer 39

Act on B1 adrenoceptors in the heart | activate them

Question 40

Why can B2 agonists cause tremors?

Answer 40

Act on B2 adrenoceptors in skeletal muscle | activate them

Question 41

How do anticholinergics treat a patient with COPD?

Answer 41

Antagonise M3 receptors in the bronchi | preventing bronchoconstriction

Question 42

What are the side of effects of using anticholingerics to treat a patient with COPD?

Answer 42

Dry mouth Supraventricular tachycardia Urinary retention

Question 43

Why can anticholinergics cause a dry mouth?

Answer 43

Block muscarinic receptors in the salivary glands | loss of parasympathetic stimulation to make them secrete

Question 44

What can anticholingerics cause a supraventricular tachycardia?

Answer 44

Block M2 receptors in the AV node | loss of parasympathetic stimulation to decrease heart rate

Question 45

Why can anticholinergics cause urinary retention?

Answer 45

Block M3 receptors in the bladder detrusor muscle | loss of parasympathetic stimulation to make it contract and expel urine

Question 46

How do methylxanthines treat a patient with COPD?

Answer 46

Bronchodilation Anti-inflammatory

Question 47

How do methylxanthines cause bronchodilation?

Answer 47

Inhibit phosphodiesterase which breaks down cAMP Less cAMP broken down more cAMP present

Question 48

What are the side effects of methylxanthines?

Answer 48

Nausea Supraventricular tachycardia Headaches, seizures

Question 49

What is an example of a methylxanthine?

Answer 49

Aminophylline

Question 50

When do long-term steroids cause side effects?

Answer 50

High dose of inhaled steroids Oral steroids

Question 51

What are the side effects of long-term steroids?

Answer 51

Thin skin, bruising Adrenal insufficiency Fluid retention

Question 52

How do mucolytics treat a patient with COPD?

Answer 52

Reduce thickness of mucus in airways | making it easier to clear

Question 53

What is an example of a mucolytic?

Answer 53

Carbocysteine

Question 54

How does long-term oxygen therapy treat a patient with COPD?

Answer 54

Prevents damage by hypoxaemia to organs e.g. heart, kidneys

Question 55

Why are patients with COPD particularly given flu vaccinations?

Answer 55

To prevent acute exacerbations of COPD | caused by infection

Question 56

When is long-term oxygen therapy used to treat a patient with COPD?

Answer 56

Persistent hypoxaemia Cor pulmonale

Question 57

What are the side effects of long-term oxygen therapy?

Answer 57

High plasma pCO2

Question 58

Why does long-term oxygen therapy cause high plasma pCO2?

Answer 58

Loss of stimulation to peripheral chemoreceptors don't stimulate increased ventilation ventilation decreases

Question 59

When is lung volume reduction surgery used to treat a patient with COPD?

Answer 59

When emphysema only affects upper lobes

Question 60

How does long volume reduction surgery treat a patient with COPD?

Answer 60

Reduces large air spaces, bullae, less dead space

Question 61

What is an acute exacerbation of COPD?

Answer 61

Temporary worsening of symptoms - cough with sputum - breathlessness on exertion Type 2 respiratory failure, respiratory acidosis

Question 62

What causes an acute exacerbation of COPD?

Answer 62

Infection

Question 63

How is an acute exacerbation of COPD treated?

Answer 63

Controlled oxygen therapy Nebulised bronchodilators Oral or IV steroids Antibiotics if have infection In don't improve, non-invasive ventilation, invasive ventilation

Question 64

What is non-invasive ventilation?

Answer 64

Ventilatory support through patient's upper airway | using a facial mask

Question 65

When should non-invasive ventilation not be used to treat a patient with an acute exacerbation of COPD?

Answer 65

Untreated pneumothroax Impaired concsciousness Upper airway secreions Facial injury Vomiting