Week 4 - COPD

Question 1

COPD stand for?

Answer 1

Chronic Obstructive Pulmonary Disease

Question 2

What is COPD?

Answer 2

Persistent and irreversible airflow limitation in the lungs.

Question 3

Main mechanisms of COPD?

Answer 3

1. Loss of elastic recoil
2. Airway narrowing

Question 4

What are main causes of COPD?

Answer 4

Inhaled toxins - cigarette smoke

(70% causes)

Genetics - notable Alpha-1 Antitrypsin Deficiency

Question 5

Explain the inflammatory response?

Answer 5

Stimulus - irritant e.g. smoke
Mediators - Neutrophils and macrophages secrete proteases. Excessive protease activity damages lung tissue. Loss of alveolar support and reduced elastic recoil.

Question 6

What happens when compliance increases due to reduced structural support?

Answer 6

Enlargement of alveolar and collapse when expiring.

Question 7

What causes hyperinflation with emphysema?

Answer 7

Increased TLC and RV due to reduction due to the person trying not to let their lung collapse.

Question 8

What causes irreversible airway narrowing?

Answer 8

Mucosal edema
Mucus hypersecretion
Bronchoconstriction
Fibrosis

Question 9

What happens to the cilia in patients with COPD?

Answer 9

Impaired mucocilary clearance due to damage to epithelium, mucosal edema, and mucus hypersecretion

Question 10

SYMPTOMS of COPD

Answer 10

Dyspnoea, Chronic cough (productive or non-producticve), wheezing, fatigue, weight loss, chest tightness.

Question 11

Chronic bronchitis phenotype

Answer 11

Blue bloater - productive cough, dyspnoea, obesity, cyanosis

Question 12

Emphysema phenotype?

Answer 12

Pink puffer - Thin body habitus, pursed lip breathing

Question 13

Complications with COPD?

Answer 13

Pulmonary hypertension, right-sided heart failure, pneumothorax.

Pulmonary hypertension - chronic hypoxia -> pulmonary vasoconstriction to redirect blood flow to more ventilated areas
Due to chronic inflammation, blood vessel walls thicken and narrow.

Right-sided heart failure (cor pulmonale) - Increased pulmonary hypertension means RV must work harder. Over-time causes RV hypertrophy (thickening of heart muscle), eventually right ventricular failure.
Venous congestion - build up fluid in the body due to blood back up - swelling in legs and abdomen and congestion in liver and other organs.

Pneumothorax - blebs form on outside of lungs and can rupture allowing air to escape into pleural space.
Increased intrapleural pressure - weakened lung structure can cause spontaneous pneumothorax if sudden increase in intra-lung pressure (e.g. coughing fit)

Question 14

Spirometry test for confirmed obstruction?

Answer 14

< 0.7 FEV1/FVC

Question 15

Spirometry severities of COPD

Answer 15

Mild
FEV1/FVC <.70
FEV1, ≥ 80% predicted

Moderate
FEV1,/FVC <.70
FEV1, between 50% and 80% predicted

Severe
FEV,/FVC <.70
FEV1, between 30% and 50% predicted

Very Severe
FEV1,/FVC <.70
FEV1, <30% predicted or
FEV1, <50% predicted + chronic respiratory failure

Question 16

Additional tests to testing COPD?

Answer 16

Pulse oximetry, arterial blood gas, chest X-ray, and genetic testing for Alpha-1 Antitrypsin Deficiency in certain cases.

Question 17

Medications for acute exacerbations?

Answer 17

Short-acting beta agonist, muscarinic antagonist, systemic steroid, antibiotics.

Question 18

Blood oxygen saturation levels

Answer 18

95-100% normal
91-95% concerning
90 or < 90 - low blood oxygen levels
80-85% - low oxygen effects brain
67% - cyanosis

Question 19

First line measures for COPD

Answer 19

Smoking cessation, pulmonary rehabilitation, vaccinations

Question 20

Pharmacological management of COPD

Answer 20

Beta agonists (smooth muscle relaxation), muscarinic antagonists (smooth muscle relaxation), inhaled corticosteroids.

Question 21

Physiotherapy management of COPD

Answer 21

Breathing exercises, help clearing phlegm (huffing), positioning for ease of breathing