COPD

Question 1

What conditions are encompassed by COPD?

Answer 1

Chronic bronchitis

Emphysema

Question 2

COPD is irreversible and progressive. T/F?

Answer 2

True

Question 3

What is the biggest risk factor for the development of COPD?

Answer 3

Smoking

Question 4

Other than smoking, what other factors can be implicated in COPD?

Answer 4

Environmental pollution
Burning of biomass fuels
Occupational dust
Alpha 1 Anti-trypsin deficiency

Question 5

What are the effects of smoking on the lungs?

Answer 5

Reduced filial motility
Airway inflammation
Mucous hypertrophy
Hypertrophy of goblet cells
Increased protease activity
Anti-protease inhibition
Oxidative stress
Squamous metaplasia

Question 6

How does alpha one anti-trypsin deficiency result in COPD?

Answer 6

Alpha one antitrypsin is a serine proteinase inhibitor. Patients with a deficiency are unable to counterbalance destructive enzymes in the lung.

Question 7

At what age do non-smokers with alpha one antitrypsin deficiency develop COPD?

Answer 7

30-40 years

Question 8

What symptom of COPD is specific to chronic bronchitis?

Answer 8

Production of sputum on most days for at least 3 months in at least 2 years

Question 9

What is emphysema?

Answer 9

Abnormal, permanent enlargement of the airspaces distal to the terminal bronchioles

Question 10

Which cells are the main drivers of inflammation in chronic bronchitis and COPD?

Answer 10

Neutrophils

Question 11

Small airways disease may be an early feature of COPD. T/F?

Answer 11

True

Question 12

Why does bronchiole narrowing occur in chronic bronchitis?

Answer 12

Mucous plugging
Inflammation
Fibrosis

Question 13

What cells are implicated in inflammation in chronic bronchitis?

Answer 13

Macrophages
CD8+ T cells
Neutrophils

Question 14

What inflammatory mediators are involved in chronic bronchitis?

Answer 14

TNF
IL-8
Other cytokines

Question 15

What substances do activated neutrophils produce in chronic bronchitis?

Answer 15

Neutrophil elastase
Proteinase 3
Cathepsin G

Question 16

What substances do activated macrophages produce in chronic bronchitis?

Answer 16

Elastase

Matrix metalloproteinases

Question 17

What types of emphysema contribute to COPD?

Answer 17

Centri-acinar emphysema

Pan-acinar emphysema

Question 18

Where in the lungs does centri-acinar emphysema cause damage?

Answer 18

Around respiratory bronchioles

Mostly in the upper lobes

Question 19

Where in the lungs does pan-acinar emphysema cause damage?

Answer 19

Uniform enlargement from the level of the terminal bronchiole distally

Question 20

What type of emphysema is associated with alpha one anti-trypsin deficiency?

Answer 20

Pan-acinar emphysema

Question 21

Why is there breathlessness in COPD?

Answer 21

Air trapping

Hyperinflation

Question 22

What signs of COPD are seen on CXR?

Answer 22

Hyperinflation appears as very dark looking lungs with >6 anterior ribs seen
Heart is thin
Hemi-diaphragm flattens

Question 23

What are the symptoms/signs of COPD?

Answer 23

Exertional breathlessness
Chronic cough
Regular sputum production
Frequent winter bronchitis
Wheeze

Question 24

What % predicted FEV1 indicates stage one COPD?

Answer 24

80%

Question 25

What % predicted FEV1 indicates stage two COPD?

Answer 25

50-79%

Question 26

What % predicted FEV1 indicates stage three COPD?

Answer 26

30-49%

Question 27

What % predicted FEV1 indicates stage four COPD?

Answer 27

<30%

Question 28

What therapies are used to treat COPD?

Answer 28

``` Inhaled bronchodilators Inhaled corticosteroids Oral theophylline Mucolytics (carbocysteine) Nebuliser therapy ```

Question 29

Give an example of a short acting inhaled bronchodilator?

Answer 29

Salbutamol

Question 30

Give an example of a long acting inhaled bronchodilator?

Answer 30

Salmeterol | Tiotropium

Question 31

Give examples of inhaled corticosteroids used in COPD

Answer 31

Budenoside | Fluticasone

Question 32

What symptoms/signs of type 2 respiratory failure are seen in COPD patients?

Answer 32

``` Cyanosis Warm peripheries Boudning pulse Flappign temor Confusion Drowsiness Right sided heart failure Oedema Raised JVP ```

Question 33

What symptoms/signs of type 1 respiratory failure are seen in COPD patients?

Answer 33

``` Desaturate on exercise Pursed lip breathing Use of accessory muscles Wheeze Undraping of intercostals Tachypnoea ```

Question 34

What are some of the main differences between COPD and asthma?

Answer 34

Strong smoking history in COPD, possible non-smokers in asthma Asthma often occurs <35 years Chronic productive cough common in COPD but not in asthma Breathlessness is persistent and progressive in COPD but variable in asthma Night time symptoms in asthma Significant diurnal variability in asthma Eosinophils and CD4+T cells in asthma, CD8+ T cells and neutrophils in COPD Asthma is reversible, COPD is irreversible

Question 35

Define an exacerbation of COPD

Answer 35

A sustained worsening of the patient's symptoms from their usual stable state, which is beyond day-to-day variations nd is cute in onset.

Question 36

How should an exacerbation of COPD be assessed?

Answer 36

Symptoms ABG CXR

Question 37

Why are the target oxygen saturations in COPD lower than for other patients?

Answer 37

Normally, respiratory drive is determined by carbon dioxide levels, sensed by chemoreceptors. In COPD there is chronic high carbon dioxide in the blood due to the obstruction of expiration and so the body will desensitise to this and will start using oxygen levels to determine respiratory drive. Thus, giving oxygen will. worsen type 2 respiratory failure as the increase in oxygen levels could remove the patient's respiratory drive.

Question 38

How should patients with exacerbations of COPD be treated?

Answer 38

``` Nebulised salbutamol 2.5-5mg Ipatropium bromide 0.5mg Consider iV aminophylline if no improvement Prednisolone 40mg Antibiotics if signs of infection Non-invasive ventilation ```

Question 39

What scoring system can be used to assess breathlessness in COPD?

Answer 39

MRC dyspnoea scale

Question 40

What criteria must a patient meet to qualify for long term oxygen therapy in COPD?

Answer 40

PaO2 of <7.3 kPa when stable OR PaO2 of 7.3 - 8 kPa and any of secondary polycythaemia, nocturnal hyperaemia, peripheral oedema and pulmonary hypertension