• Give your own definition of COPD

COPD stands for chronic obstructive Pulmonary Disease. It is the different combination of bronchial asthma, emphysema, and chronic bronchitis to different degrees.

• Briefly describe the proposed aetiology and pathophysiology of chronic bronchitis and emphysema.

Chronic Bronchitis: It is non-specific COPD characterised by: increased mucus secretion (mucus hypersecretion), decreased mucociliary clearance regular bacterial respiratory infections, structural changes in bronchial walls and a chronic cough due to thick mucus.

Emphysema: Often develops due to smoking and irritants. Emphysema is IRREVERSIBLE widening of respiratory bronchioles and alveoli, due to structural damage. The Damage cannot be reversed. Air is trapped in lungs which makes expiration difficult. The decreased capillary blood vessels impedes gaseous exchange.

• Which types of therapy are included in the treatment of a COPD patient?

The types of therapy are: self-management, bronchodilators, inhaled corticosteroids, methylxanthines, oxygen and surgery.

Stop smoking:

• • Extremely important and is necessary to prevent progression. Psychotherapy, consultation, and encouragement (rather positive than cautionary), as well as support, possibly with other drugs, is important to wean the smoke

If bacterial infection

• • influenza immunization (prevents 2ndary infections)
  • broad spectrum antibiotics (tetracyclines, amoxicillin, ampicillin, erythromycin, co-trimoxazole)

Obstruction of airflow

• • Bronchodilators

Mucus secretions

• • Dilute mucus (rehydration & steam)
  • Rehydration (sufficient intake of liquids) & regular steaming (humidifier)

Hypoxia

• • Oxygen inhalation. The morbidity and mortality in serious grades of COPD improve drastically with 18-24 hours/day O2 inhalation therapy. It is therefore strongly recommended in cases of continued hypoxia (various types of portable O2 containers are available).  Some patients require O2 inhalation therapy only with exercise or during sleep

Poor lung capacity

• • Light/ moderate exercise
• Why is ipratropium more effective in the treatment of chronic bronchitis than in the treatment of bronchial asthma?

Bronchial asthma is characterized by inflammation and Ipratropium does not have an anti-inflammatory effect and will thus not be as effective in treating bronchial asthma.

• In which way do the skeletal muscle effects of theophylline have advantages in the treatment of COPD?

Skeletal Muscle effects: Strengthens contraction of diaphragm skeletal muscles. Improves ventilation response, reduces hypoxia and dyspnea in COPD patients.

• What is the role of oxygen therapy in COPD?

If the combination of ipratropium, a b2-sympathomimetic and theophylline does not provide enough relief and the patient is unable to receive enough oxygen, oxygen therapy must be applied.