COPD

Question 1

Define COPD

Answer 1

A UN-CURABLE lung disease that is characterised by chronic obstruction of lung airflow and is not FULLY REVERSIBLE

Question 2

What is main cause of COPD and other causes

Answer 2

1. Smoking
   - Small lungs
   - Females
   - Biofuel, pollution certain jobs

Question 3

What is the name of the important curve in regards to smoking and death

Answer 3

Fletcher- Peto Curve

Question 4

What is Alpha -1- antitrypsin deficiency

Answer 4

A RARE disease where a protease inhibitor that is normally made in the liver and down regulates elastase is not produced.

Question 5

What is seen in people with Alpha -1- antitrypsin deficiency

Answer 5

Alveolar damage and emphysema (BASALLY)

Question 6

Why is smoking really really bad if you have Alpha -1- antitrypsin deficiency

Answer 6

Smoking increases Elastase production

Question 7

What can Alpha -1- antitrypsin deficiency lead to

Answer 7

Liver disease and cirhosis

Question 8

What are typical presenting symptoms of COPD

Answer 8

S.O.B
Recurrent chest infections
On going productive cough
Wheeze

Question 9

What scale is used to measure breathlessness

Answer 9

The MMRC dypsnoea scale (0-4)

Question 10

What are indirect presenting symptoms of COPD

Answer 10

Weight loss (cachexia) or gain 
Fatigue 
Cor Pulmonale 
Decreased exercise 
Ankle swelling  
Depression/Anxiety

Question 11

If someone comes in with previously diagnosed COPD that is getting worse, what are you looking for

Answer 11

Cyanosis (sat<92%) 
Raised Jugular Venous pressure 
Pursed lip (Define) 
Hyper Inflated chest 
Peripheral oedema

Question 12

Whats it called when someone with COPD gets acutely worse symptoms

Answer 12

Acute exacerbation of COPD

Question 13

How do you diagnose COPD?

Answer 13

Typical Symptoms
Presence of risk factor (eg smoking)
>35 years old
Absence of clinical features of Asthma

Question 14

How can you differentiate COPD symptoms from Asthma Symptoms?

Answer 14

Post bronchodilator spirometry confrims airway obstruction. (COPD IS NOT REVERSIBLE)

Question 15

How is FEV1 used to stage COPD?

Answer 15

IF RATIO LESS THAN 80% THEN INDICATES COPD 
Mild - 80%
Moderate - 50-79%
Severe - 30-49%
Very Severe - <30%

Question 16

What do you look for on COPD X-ray

Answer 16

Flat Diaphragm
Small (vertical) Heart
Vascular Hila
Bulla

Question 17

What tests can you use to help diagnose COPD

Answer 17

Spirometry
PEFR (peak expiratroy flow rate)
Chest Xray

Question 18

In COPD , what happens to the residual volume and total lung capacity

Answer 18

They increase

Question 19

What are the two diseases that are occur in COPD

Answer 19

Chronic Bronchitis (clinical)
Emphysema (pathological)

Question 20

What is chronic bronchitis

Answer 20

inflammation of large and small airways with Goblet and mucous cell hyperplasia producing lots of mucous

Question 21

When is chronic bronchitis diagnosed

Answer 21

When patient has a sputum productive cough for at least three months out of a year for a 2 year period.

Question 22

What are typical symptoms of bronchitis

Answer 22

Cyanotic
Overweight
Wheeze
Elevated Haemoglobin

Question 23

Define Emphysema

Answer 23

Airspaces distal to terminal bronchiole is increased beyond normal due to destruction of their walls or dilatation. There is no obvious fibrosis

Question 24

An xray of emphysema would show..

Answer 24

Hyperinflation

Flattened diaphragm

Question 25

What are the 4 types of Emphysema

Answer 25

Centriacinar - effects apex of lung and found in long standing smoking. Starts at terminal bronchioles and then moves distally. Panaciner - found basally and in people with Alpha-1 trypsin deficiency Periaciner Scar/irregular/Bullous - a Bulla is found in the emphysematous space. Not a problems unless bursts and causes spontaneous pneumothorax

Question 26

On Auscultation, what would emphysema sound like

Answer 26

Quiet chest.

Question 27

How can severe COPD causes Hypoxaemia? (x4)

Answer 27

V/Q mismatch (most common) Diffusion impairment Alveolar Hypoventilation Shunt

Question 28

What can happen in severe COPD

Answer 28

Ventilatory failure (type 1 and 2) Cor Pulmonale Secondary Polycythaemia

Question 29

What is type 1 and type 2 ventilatory failure

Answer 29

type 1 - low O2 and Co2 normal or low | Type 2 - low 02 and high CO2 (hypoxic drive)

Question 30

What is hypoxic drive

Answer 30

High levels of Co2 desensitizes the central chemoreceptors and the body relies on peripheral chemereceptors and oxygen pO2 to control breathing.

Question 31

What is secondary Polycythaemia

Answer 31

The body produces more EPO in response to low Po2. This increases hematocrit and blood viscosity.

Question 32

What are the differentials to COPD

Answer 32

Pneumonia Lung cancer Pleural Effusion Pneumothorax

Question 33

What are the non-pharmalogical managements of COPD

Answer 33

Smoking cessation (effects take a while) Annual Flu and Pneumococcal vaccine (reduces hospital admissions) Pulmonary rehab - most beneficial Nutritional assessment (small meals) Psychological support

Question 34

Does pharmacological intervention reduce mortality

Answer 34

NOPE | They are used to relieve symptoms, prevent exacerbations and improve QOL

Question 35

What drugs would you prescribe for COPD

Answer 35

``` Short acting Bronchodilators - SABA - salbutamol -SAMA - ipratropium Long acting bronchodilators - LAMA - tiotropium - LABA salmeterol High Dose inhaled corticosteroids -ICS ```

Question 36

If COPD more common in males are females?

Answer 36

Females

Question 37

What is the treatment for an acute exacerbatin

Answer 37

short acting bronchodilators Steroids for 5-7 days Antibiotics (only if a bacterial infection) Admit to hospital if sats <92%, tachynpoea or hypotension

Question 38

What significant symptoms are not usually found with COPD

Answer 38

Finger clubbing Haemoptysis Chest pain