32 Questions
What is a common symptom of COPD that patients often experience?
Cough and sputum production
What is a complication of COPD that can lead to respiratory failure?
Pulmonary vascular remodeling
At what age should COPD be suspected in a patient with chronic cough or breathlessness?
40 years
What is a physical examination finding in severe COPD?
Cyanosis
What is a feature of COPD that worsens over time?
Dyspnea
What is a systemic feature of COPD?
Muscle wasting
What is a reason for suspecting another condition rather than COPD as the cause of haemoptysis?
Haemoptysis requires thorough investigations to exclude other conditions
What is a breathing pattern observed in patients with severe COPD?
Pursed-lip breathing
In COPD patients, what is the characteristic feature of the chest?
Barrel chest
What is the typical finding on cardiac examination in COPD patients?
Loud heart sounds in the epigastrium
What is the characteristic lung finding in COPD patients?
Hyper-resonance
What is the significance of finger clubbing in COPD patients?
It suggests associated lung cancer, bronchiectasis or fibrosis
What is the significance of oedema in COPD patients?
It is a sign of right heart failure
What is the typical spirometry finding in COPD patients?
FEV1/FVC ratio < 80% of predicted
What is the typical medication used in COPD patients?
All of the above
What is the typical dose of oral prednisolone used in COPD patients?
40 mg daily for 5 days
What is the definition of COPD?
A preventable and treatable disease characterized by persistent respiratory symptoms and airflow limitation
What is the main risk factor for COPD?
Cigarette smoking
What is the prevalence of COPD worldwide?
Around 80 million people
At what age is COPD more prevalent?
After 40 years of age
What is the expected ranking of COPD as a cause of death in the coming decade?
3rd leading cause of death
What is emphysema?
An anatomically defined condition characterized by abnormal permanent enlargement of the airspaces
What is the minimum pack year required to develop COPD?
10 pack year
What is chronic bronchitis?
A clinically defined condition characterized by cough and sputum on most days for at least 3 months in each of 2 successive years
What is a common mode of cooking in some countries that leads to high levels of indoor pollution?
Biomass solid fuel fires
What is associated with early onset COPD with predominant emphysema?
Alpha-1-antitrypsin deficiency
What is the main component of the inflammatory cell infiltration in chronic bronchitis?
Neutrophils
What is the result of the balance between the elastic recoil of the lung and the resistance of the airways?
Airflow during expiration
What is the main pathology in COPD?
Airway limitation
What is the result of the progressive destruction of the alveolar cells and matrix in emphysema?
Enlargement of the distal airspaces
What may form in some patients with emphysema?
Bullae
What is a contributing factor to the development of airflow obstruction in COPD?
All of the above
Study Notes
Definition and Epidemiology
- COPD is a preventable and treatable disease characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities.
- The prevalence of COPD is directly proportional to the prevalence of smoking in the community.
- Around 80 million people worldwide suffer from moderate to severe COPD.
- COPD is more common in men, but the prevalence among women is increasing.
- The disease is more prevalent after 40 years of age.
Aetiology
- Cigarette smoking is the major risk factor for COPD (accounts for 95% of cases) and relates to both the amount and duration of smoking.
- Other exposures that contribute to COPD include biomass solid fuel fires, occupational exposure to coal, silica, and cadmium, and low birth weight and impaired lung growth in childhood.
- Genetic factors, such as alpha-1-antitrypsin deficiency, can also contribute to early onset COPD.
Pathology
- COPD has both pulmonary and systemic components.
- Chronic bronchitis is characterized by excess goblet cells and enlarged mucus-secreting glands with inflammatory cell infiltration, resulting in increased sputum production.
- Emphysema is characterized by chronic exposure to cigarette smoke, leading to inflammatory cell recruitment, protease release, and alveolar cell death.
- Airway limitation (obstruction) results from both small airway obstruction and emphysema.
Clinical Features
- COPD should be suspected in patients over 40 years old with chronic cough or breathlessness.
- Symptoms include chronic cough, sputum production, and exertional dyspnoea.
- As the disease advances, dyspnoea worsens, and patients become breathless on doing simple activities of daily living and even at rest.
- Physical examination may reveal breathlessness, prolonged expiration, pursed-lip breathing, and use of accessory muscles of inspiration.
Investigations
- The diagnosis of COPD requires objective demonstration of persistent airflow obstruction by spirometry.
- FEV1/FVC ratio is used to classify disease severity: moderate (50% - 80%), severe (30% - 50%), and very severe (<30%).
Management
- Bronchodilators, such as SABA (salbutamol) combined with ipratropium bromide, are used to treat COPD.
- Corticosteroids, such as oral prednisolone, reduce symptoms and improve lung function.
- Oxygen therapy is used to manage acute exacerbations, but high concentration of oxygen may cause respiratory depression.
This quiz covers the definition, pathophysiology, diagnosis, and management of Chronic Obstructive Pulmonary Disease (COPD).
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