• Give your own definition of COLS

COLS is a chronic obstructive airways disease characterized by limited airflow through the lungs, difficult breathing, hypoxia, cough and sleep disorders. There are currently 3 conditions that can be linked to COLS, viz. Bronchial asthma, Chronic bronchitis and Emphysema.

• Briefly describe the proposed etiology and pathophysiology of chronic bronchitis and emphysema

Chronic bronchitis: The etiology is still unclear, but it appears to be caused by long-term exposure to irritants such as cigarette smoke, dust and irritating gases. It is characterized by coughing, excessive mucus secretions, decreased mucosal clearance, increase in the incidence of bacterial airway infections and structural changes in the bronchial wall. Chronic bronchitis is associated with an overactive parasympathetic nervous system as it induces the vagus reflex of irritant receptors in the airways.

Emphysema: It is the irreversible dislocation of the bronchioli and alveoli that causes air to be trapped in the respiratory spaces of the lungs, but is very difficult to exhale. There is also reduced blood flow through the capillary blood vessels which further complicates gas exchange. It is very strongly associated with cigarette smoking from heavy smokers and genetically susceptible individuals

• What types of therapy are included to treat a COLS patient?

A step-by-step approach to therapy is used:

Anti-cholinergic therapy serves as the first line of therapy: Ipratropium inhalation is usually indicated

If the anti-cholinergic therapy is not sufficient, it can be used in combination with a Beta2 agonist and / or a slow-release form of theophylline

If necessary, additional oxygen therapy can be added

Oral / inhalation therapy of corticosteroids may also be added if no. 2 is not sufficient

With acute disease: Hospitalization with maximal bronchodilator and systemic corticoid therapy, physiotherapy, oxygen and if necessary: ​​antibiotics

• Why is ipratropium more effective in treating chronic bronchitis than in treating bronchial asthma?

Ipratropium is an anti-cholinergic agent which therefore cooperates with the parasympathetic nervous system. It is an M3 receptor antagonist in the airways. Chronic bronchitis is associated with an overactive parasympathetic nervous system, as it mediates the vagus reflex that types are induced after stimulation of airway irritant receptors. Ipratropium therefore counteracts this effect. While in bronchial asthma inflammatory conditions are central, for which Ipratropium will be ineffective.

• In what ways do the skeletal muscle effects of theophylline have benefits in the treatment of COLS?

Theophylline causes increased diaphragm contractility which means it improves ventilatory capacity

• What is the role of oxygen therapy in COLS?

In severe cases of COLS, hypoxia is a serious problem. 18-24 hours / day oxygen inhalation therapy improves morbidity and mortality. In some cases, some patients only need oxygen therapy before exercise or during sleep