Which conditions comprise COPD? Chronic bronchitis – Productive cough for 3 months of the year, for 2 consecutive years Emphysema – Abnormal, permanent enlargement of air spaces (distal to terminal bronchiole)
How does COPD present? Symptoms Productive cough (clear/white sputum) Wheeze Shortness of breath If severe: Tachypnoea Use of accessory muscles Intercostal recession Pursed lips
How does COPD present? Responsive to CO2 Pink puffer Tachypnoeic Pink Insensitive to CO2 Blue bloater Cyanosis Oedema
What can cause COPD/ trigger an exacerbation? Caused by… Smoking Alpha-1 antitrypsin deficiency Triggered by… Infection Cold weather Atmospheric/occupatio nal pollution
Which co-morbidities are COPD patients likely to have? Ischaemic heart disease Hypertension Diabetes Heart failure Cancer
What is the pathophysiology of COPD? Chronic bronchitis Hypertrophy and hyperplasia of goblet cells (mucus) Columnar squamous epithelium due to chronic inflammation Airway thickening and narrowing. Airflow limitation. Emphysema Dilation and destruction of lung tissue Loss of elastic recoil Expiratory airflow limitation and air trapping Caused by long term exposure to toxic particles and gases e.g. smoking
What is the difference between asthma and COPD? Asthma is a reversible and transient obstruction of the airways. COPD is an irreversible and progressive obstruction of the airways. (They are both examples of obstructive airway disease)
COPDASTHMA Smoker or ex-smokerMostPossibly Symptoms under age 35RareCommon AtopyUncommonCommon Cellular infiltrateMacrophages Neutrophils CD8+ T cells Eosinophils CD4+ T cells Cough and sputumDaily/commonIntermittent BreathlessnessPersistent/progressiveVariable Night time symptomsUncommonCommon Significant diurnal variability of symptoms UncommonCommon Bronchodilator response (FEV1, PEFR) <15%>20% Corticosteroid responsePoorGood What is the difference between asthma and COPD?