| What is COPD | The airflow obstruction is usually progressive, not fully reversible, and does not change markedly over several months
Not fully reversible is an important diagnostic marker
The disease is predominantly caused by smoking |
| What is emphysema | A pathological process in which there is destruction of the terminal bronchioles and distal airspaces
Leads to loss of alveolar surface area → Reduced ventilation |
| What can emphysema lead to | Destruction of tissues removes ‘scaffolding’ support of small airways, which tend to collapse
Leads to airflow obstruction
Lung recoil reduced so lungs have higher resting expiratory level --> Hyperinflation
Bullae can also burst leading to pneumothorax |
| What are the 2 types of emphysema | Centrilobular --> occurs primarily in the upper lobes due to loss of bronchioles
Panlobular --> Involves all lung fields |
| What is chronic bronchitis | Chronic mucus hypersecretion --> frequent infections and a persistent cough
This leads to increase amount of inflammation in the airways which leads to remodelling and narrowing of the airways |
| What are some causes of COPD | Vast majority in HICs due to smoking
Alpha 1 antitrypsin deficiency --> young patients presenting with COPD
Occupational exposure eg coal dust
Pollution --> including indoor smoke pollution |
| What are some common symptoms of COPD | Cough and sputum production
Followed by progressive breathlessness → dyspnoea
Increasingly frequent exacerbations
Breathlessness |
| What are some signs of COPD | Pursed lip breathing --> to increase pressure to keep the airways open
Usage of accessory muscles
Tachypnoea
Wheezing/quiet breath sounds
Hyperinflation |
| As the disease progresses what can happen | Cyanosis
Carbon dioxide retention
Right heart failure |
| What are some differences between Asthma and COPD | Smoker or ex smoker → Almost every time in COPD but possibly in Asthma
Symptoms under age of 65 → Rare in COPD and often in asthma
Chronic cough → Common in COPD but not Asthma
Nighttime waking with breathlessness → Common in Asthma not in COPD
Significant day-day variability of symptoms → Common in Asthma not in COPD |
| What are some investigations you can run | Spirometery
Chest x-ray not diagnostic but can help
High resolution CT scan can help to assess destruction in emphysema
Arterial blood gases to assess respiratory failure
Alpha-1 anti trypsin assay for younger patients |
| What is cor pulmonale | Cor pulmonale is a condition that causes the right side of the heart to fail.
Long-term high blood pressure in the arteries of the lung and right ventricle of the heart can lead to cor pulmonale |
| What are some management plans | Smoking cessation support
Pulmonary rehabilitation
Bronchodilators
Diet
Steroids
Influenza vaccination
Long term oxygen therapy in advanced disease
Drugs such as : Beta-2 agonists , Antimuscarinics , Corticosteroids |
| What are some adverse effects of beta-2 agonists | Tachycardia
Tremor
Anxiety
Palpitations
Hypokalaemia |
| What are some adverse effects of Anti-muscarinics | Acute glaucoma
Urinary difficulty → urinary retention
Atrial fibrillation
Tachycardia |
| What are some adverse effects of corticosteroids | Thin skin
Bruising
Diabetes / Osteoporosis
Cataracts
Increased weight |
| What are Blue bloaters and pink puffers mean? | The” blue bloaters” represent those who have chronic bronchitis and the “pink puffers” represent patients with emphysema |
