COPD

Question 1

2 types of COPD

Answer 1

• Emphysema

- Chronic bronchitis

Question 2

Simple pathology behind COPD

Answer 2

• Airway and/or alveolar abnormalities

- Mixture of small airway disease and parenchymal destruction

Question 3

Define chronic bronchitis

Answer 3

Chronic productive cough for 3 months in 2 successive years - with other causes of chronic cough excluded
- Inflamed bronchi and excessive sputum production

Question 4

Define emphysema

Answer 4

Abnormal and permanent enlargement of the airspaces distal to the terminal bronchioles
- Destruction of airspace walls, without obvious fibrosis

Question 5

Subtypes of emphysema

Answer 5

• Proximal acinar
• Panacinar
• Distal acinar

Question 6

Gender prevalence COPD

Answer 6

M > F

Mortality M = F

Question 7

COPD is the …. leading cause of death globally

Answer 7

5th

Question 8

Is COPD prevalence increasing/decreasing?

Answer 8

Increasing

Question 9

Prevalence of COPD in the population

Answer 9

5-10%

Question 10

COPD aetiology

Answer 10

• Tobacco smoking (40-70%)
• Air pollution
• Occupational exposure
• Alpha-1-anti trypsin deficiency

Question 11

Relationship between tobacco smoking and COPD

Answer 11

• Inflammatory response
• Cilia dysfunction
• Oxidative injury

Question 12

Alpha-1-anti trypsin deficiency and COPD

Answer 12

Panacinar emphysema at a younger age

Question 13

With COPD, the prominant pathologic changes are seen where?

Answer 13

Airways (changes also seen in lung parenchyma and pulmonary vasculature)

Question 14

Pathological changes seen in COPD depend on….

Answer 14

• Underlying disease
• Individual susceptibility
• Disease severity

Question 15

Airway changes seen in COPD

Answer 15

• Chronic inflammation
• Increased number of goblet cells
• Mucus gland hyperplasia
• Fibrosis
• Narrowing
• Decreased number of small airways
• Airway collapse (loss of tethering caused by alveolar wall destruction in emphysema)

Question 16

Cells involved in COPD inflammation

Answer 16

• CD8+
• T cells
• Neutrophils
• Macrophages

Question 17

Cells involved in asthma inflammation

Answer 17

• CD4+
• Eosinophils
• Interleukins

Question 18

Emphysema affects structures …. to the terminal bronchiole

Answer 18

Distal

Question 19

What structures make up an acinus

Answer 19

• Alveolar ducts and sacs (with capillaries and interstitium = parenchyma)

Question 20

Proximal acinar emphysema location and cause

Answer 20

• Centrilobar
• Smoking
• Pneumoconiosis

Question 21

Panacinar emphysema location and cause

Answer 21

• All parts of the alveolar duct and sac
• A-1-A deficiency
• Smoking

Question 22

Distal acinar emphysema location and cause

Answer 22

• Paraseptal

- Spontaneous pneumothorax

Question 23

What happens to pulmonary vasculature in COPD

Answer 23

• Intimal hyperplasia
• Smooth muscle hypertrophy and hyperplasia
• Due to chronic hypoxic vasoconstriction of small pulmonary arteries

Question 24

Do eosinophils play a role in COPD

Answer 24

No (except for acute exacerbations)

Question 25

Emphysema inflammation causes what to happen

Answer 25

- Elastin breakdown | - Loss of alveolar integrity

Question 26

Chronic bronchitis inflammation causes what to happen

Answer 26

- Ciliary dysfunction | - Increase goblet cell size and number

Question 27

COPD and hyperinflation

Answer 27

- Increased airway resistance - Expiratory flow limitation - Hyperinflation

Question 28

COPD and hypoxia

Answer 28

- Vascular smooth muscle thickening - Leads to pulmonary hypertension - Worsens hypoxia

Question 29

3 main symptoms of COPD

Answer 29

- Dyspnoea - Chronic cough - Sputum production

Question 30

Other symptoms of COPD

Answer 30

- Wheeze - Course crackles - Chest tightness - Cough syncope - Weigh loss of gain - Use of accessory muscles - Intercostal retraction - Barrel chest - Hyperresonance - Quiet/absent breath sounds - Asterixis (hypercapnia)

Question 31

COPD comorbid diseases

Answer 31

- Lung cancer - Bronchiectasis - CVD - Osteoporosis - Metabolic syndrome - Skeletal muscle weakness - Anxiety - Depression

Question 32

COPD investigations

Answer 32

- Spirometry - CXR - Pulse oximetry - FBC - ECG - ABG - Sputum culture - Chest CT - Exercise study

Question 33

Findings on spirometry with COPD

Answer 33

- Decreased FEV1 | - Decreased FEV1/FVC (<0.7)

Question 34

Risk factors for COPD

Answer 34

- Cigarette smoking - Advanced age - Genetic factors - White ancestry - Exposure to pollution - Developmentally abnormal lungs - Male - Low SES

Question 35

Main goals of treatment of COPD

Answer 35

- Prevent and control symptoms - Reduce severity and number of exacerbations - Improve respiratory capacity - Reduce mortality

Question 36

What is the GOLD criteria for COPD

Answer 36

- Global initiative for chronic obstructive lung disease - Assess different stages of COPD - >18 years old and already diagnosed via spirometry - Guides treatment - Group A-D

Question 37

Treating an acute exacerbation of COPD

Answer 37

1. Short acting bronchodilator (salbutamol) 2. Systemic corticosteroid 3. Inhaled corticosteroid 4. Supplemental O2 Add antibiotics if an infectious exacerbation

Question 38

Ongoing/long term treatment for COPD

Answer 38

1. Short and long acting bronchodilator 2. Education 3. Vaccination - influenza and pneumococcal

Question 39

What is the CODEX index for COPD

Answer 39

- Cormorbidities, obstruction, dyspnoea, previous severe exacerbations

Question 40

Complications of COPD

Answer 40

- Cor pulmonale - Recurrent pneumonia - Depression - Pneumothorax - Respiratory failure - Anaemia (25% of COPD patients are anaemic) - Polycythaemia