COPD lms

Question 1

chronic bronchitis

Answer 1

chronic inflammation of airways with excess mucous production
leads to narrowing of airways

Question 2

emphysema

Answer 2

dilatation of the airways distall to the terminal branchioles
destruction of alveili with bullae formation and lossof lung elaasticity leading to trapping of air and lung hyperinflation

Question 3

alpha-1 antitrypsin deficiency

Answer 3

rare cause of emphysema
autosomal recessive
normal genotype is PiMM, heterozygotes are PiMz and homozygotes are PiZZ
homozygotes with pool antitrypsin in the liver because they cannot transport it out of the liver causing liver cirrhosis
deficiency of antitrypsin in the blood means they cannot protect the lungs from endogenous proteases

Question 4

suspect alpha 1 antitrypsin deficiency in

Answer 4

emphysema with no or minimal smoking history
or severe emphysema in smoker aged under 40

Question 5

typical histroy of COPD

Answer 5

generally over 50
a smoker or ex smoker with a smoking history of at least 20 pack years
presents with gradually worsening cough, often productive of sputum, shortness of breath, wheeze

Question 6

signs on mild/moderate COPD

Answer 6

may hear wheeze or crackles if predominant bronhcitis
breath sounds in emphysema are quiet due to loss of lung tissue or may be normal

Question 7

signs of severe COPD

Answer 7

hyperexpanded barrel chest
may be using accessory muscles of respiration
may exhibit pursed lip breathing (to keep the pressure of the small airways up so they dont collapse on expiration)
cyanosed
angle oedema
cechectic with muscle wasting

Question 8

ssigns of respiratory failure

Answer 8

if in respiratory failure with carbon dioxide retention, may have a flapping treemor, papilloedema, confusion and peripheral vasodilatation

Question 9

confirming the diagnosis of COPD

Answer 9

full smoking histroy
spirometry - FEV1 and FVC
CXR is not a diagnsotic test - often normal in mild/moderate cases

Question 10

imporrtance of spirometry

Answer 10

better measure of small airway function
prognostic value
FEV1 60-80% : mild
FEV1. 40-60% : moderate
FEV1<40 : severe

Question 11

CXR in severe COPD

Answer 11

flattened diaphragm due to hyperinflation
large volume lungss
hyerlucent areas due to the presence of bullae

Question 12

differential diagnoses

Answer 12

asthma - wheeze and cough
bronchiectasis - cough and excessive sputum production
idiopathic. pulmonary fibrosis - gradually worsening breathlessness and cough
lung cancer - chronic cough, although history usually shorteer than in COPD

Question 13

distinguishing featuress beetween COPD and asthma

Answer 13

COPD: not usually woken at night by symptoms, little variation in severity, never completely free of symptoms, may be some improvement on coritocsteroids but often none
asthma: symptoms often worse at night or cause waking, may be marked day to day variability, may be entirely well between attacks, marked therapeutic response to corticosteroids

Question 14

complications of COPD

Answer 14

exacerbations
resppiratory failure (type 1 if normocapnia, or type 2 if hypercapnia)
pulmonary hypertension (causing right heart failure)
pneumothorax

Question 15

management of COPD

Answer 15

smoking cessation
inhaled bronchodilators -
short: beta 2 agonsits (salbutamol and terbutaline) or antimuscarinics (iprotropium)
long: beta 2 agonists and antimuscarinics

Question 16

why not use inhaled steroids

Answer 16

increasing body of evidence for risk of long term high dose inhaled. steroids including oneumonia and mycobacterial infection
reserve inhaled steroids for COPD exacerbations