COPD

• What does COPD stand for?

  Chronic Obstructive Pulmonary Disease
• What conditions are included under the umbrella term COPD?

  • Chronic bronchitis
  • Emphysema
  • Small airways disease
• What is the definition of chronic bronchitis?

  Cough productive of purulent sputum for 3 months
• How long must chronic bronchitis symptoms persist?

  At least 3 months for 2 successive years
• What is emphysema characterized by?

  Destruction of lung tissue distal to terminal bronchioles
• What happens to the bronchial walls in emphysema?

  There is a degenerative loss of radial traction
• What is small airways disease associated with?

  Thickening of airway walls and fibrosis
• How many people are estimated to have COPD in England and Wales?

  900,000 expected to be 1.5 million
• What is COPD's rank as a cause of death in the UK?

  Fifth biggest killer in the UK
• How many deaths from COPD occurred in the UK in 2003?

  26,000 deaths
• What factors increase mortality in COPD?

  Age, disease severity, and poverty
• What percentage of admitted COPD patients die within three months?

  15%
• What are common environmental causes of COPD?

  Cigarette smoking and coal dust exposure
• What deficiency can lead to emphysema?

  Alpha-1-antitrypsin deficiency
• What is the pathophysiology of chronic bronchitis?

  • Tobacco smoke irritates bronchus
  • Inflammatory response occurs
  • Goblet cells and mucus glands stimulated
  • Increased mucus in airway lumen
  • Destruction of cilia and flattening of epithelial cells
• What is the pathophysiology of emphysema?

  • Inflammatory cells release proteases
  • Proteases overwhelm anti-proteases
  • Destruction of alveolar walls (elastin and collagen)
  • Loss of airway support causes floppy airways
  • Narrowing or collapse on expiration leads to wheeze
• What are the symptoms and signs of emphysema?

  • Airflow obstruction
  • Gas trapping (high retention volume)
  • Hyperinflation of the chest
  • Loss of capillary bed
  • Reduced blood flow through lungs
  • Pulmonary hypertension / cor pulmonale
• What are the symptoms and signs of bronchitis?

  • Production of purulent sputum
• What investigations are used for chronic bronchitis?

  • Smoking history
  • Sputum analysis
• What investigations are used for emphysema?

  • Smoking history
• How can asthma be differentiated from COPD?

  Asthma patients are often never smokers
• What are the treatment options for COPD?

  • Smoking cessation
  • B2 agonists (e.g., Salbutamol)
  • Muscarinic antagonists (e.g., Ipratropium, Tiotropium)
  • Pulmonary rehabilitation
  • Surgery (Bullectomy, Lung Volume Reduction, Lung Transplant)
• What is the role of B2 agonists in COPD treatment?

  They facilitate bronchodilation
• What is the role of muscarinic antagonists in COPD treatment?

  They reduce bronchoconstriction
• What does pulmonary rehabilitation involve?

  • Exercise
  • Disease management
  • Counseling
• What surgical options are available for severe COPD cases?

  Bullectomy, lung volume reduction, lung transplant
• How does the pathophysiology of chronic bronchitis differ from emphysema?

  Chronic bronchitis involves mucus production, emphysema involves alveolar destruction
• What is the relationship between smoking and COPD?

  Smoking is a major cause of COPD development
• What is the significance of alpha-1-antitrypsin in emphysema?

  Its deficiency leads to increased risk of emphysema
• What is a common symptom of bronchitis?

  Production of purulent sputum
• What is the impact of pulmonary hypertension in COPD?

  It can lead to cor pulmonale