COPD recap

• Chronic Bronchitis:

  • A clinical diagnosis defined by the presence of a wet textured chronic productive cough for three months in each of two successive years in a patient in whom other causes of chronic cough have been excluded
  • excessive sputum production
  • wet smokers cough first thing in the morning - common symptom
  • chronic bronchitis can be colonised by infectants and lead to pneumonia
• Emphysema:

  • A pathological term describing the abnormal permanent enlargement of airspaces distal to the terminal bronchioles, accompanied by destruction of their walls without obvious fibrosis
  • proteins from smoking causes body to release protease -> protease starts to break down walls of alveoli and decrease surface area -> presence of bullae and destruction of capillary bed -> airways/lungs become "floppy"
  • can lead to heart failure
• COPD:

  • umbrella term for:
  • Chronic bronchitis
  • Emphysema
  • commonly caused by smoking
• Chronic Bronchitis Pathophysiology:

  • Narrowing of the airway due to inflammatory changes:
  • Mucosal oedema
  • Smooth muscle hypertrophy
  • Peri-bronchial fibrosis
  • Excess bronchial secretions due to:
  • Hypertrophy & hyperplasia goblet cells
  • Reduced ciliary function
  • Bacterial colonisation & repeated infection
• Emphysema Pathophysiology:

  • Permanent enlargement of the air spaces distal to the terminal bronchiole
  • Protein breakdown leads to erosion of alveolar septa, dilation of distal air spaces and destruction of elastic fibres
  • Formation of bullae
  • Destruction of the capillary bed
  • Airways become floppy due to loss of radial traction
• Pharmacology for COPD:

  • Bronchodilators
  • Steroids
  • Diuretics (RVF)
  • Long term oxygen therapy (LTOT)
  • Antibiotics (infective exacerbations)
  • Flu vaccine
• Surgery for COPD:

  • Lung volume reduction surgery (LVRS) for emphysema
  • Remove bullae
  • Relieves compression of healthy lung tissue
  • Lung volume reduced
  • Improved length-tension of diaphragm (domed)