COPD: Overview and Practice Questions

Chronic obstructive pulmonary disease (COPD) is a lung disorder that makes it difficult to breathe. It results in wheezing, shortness of breath, and chest tightness, and is the fourth leading cause of death in the United States.

In this article, we will provide an overview of COPD, including its symptoms, causes, and treatment options. We included healful practice questions for your benefit as well. So, let’s get started!

What is COPD?

COPD is a chronic respiratory disease that results in difficulty breathing due to narrowing of the airways within the lungs. It is a progressive disease, meaning it gets worse over time.

COPD is caused by exposure to irritants such as cigarette smoke, secondhand smoke, air pollution, and chemical fumes. The symptoms of COPD typically don’t appear until middle age, and the disease progresses slowly.

Signs and Symptoms

The most common symptom of COPD is shortness of breath, which can happen even when performing simple activities such as walking or climbing stairs. Other symptoms include:

• Dyspnea
• Wheezing
• Chest tightness
• Coughing up mucus
• Fatigue

Each patient’s experience with COPD is unique, and many people also experience anxiety and depression due to the limitations caused by their disease.

Causes

COPD is caused by long-term exposure to irritants like cigarette smoke, secondhand smoke, air pollution, and chemical fumes.

Exposure to these substances damages the lungs over time and causes inflammation that narrows the airways within the lungs. There are a number of risk factors for developing COPD, including:

• Exposure to cigarette smoke
• Exposure to secondhand smoke
• Living in a polluted area
• Working in a job that exposes you to chemical fumes or dust

Genetic factors can also play a role, as people with relatives who have COPD are more likely to develop the disease.

Treatment

COPD cannot be cured, but there are a number of treatment options available to help manage the symptoms and slow the progression of the disease. These include:

• Inhaled bronchodilators
• Inhaled corticosteroids
• Lifestyle changes such as quitting smoking and avoiding exposure to irritants
• Pulmonary rehabilitation
• Low-flow oxygen therapy
• Noninvasive ventilation
• Mechanical ventilation (in severe cases)

The treatment method will vary with each patient depending on the severity of the patient’s signs and symptoms.

Bilevel positive airway pressure (BiPAP) is the preferred method of treatment during an acute exacerbation of COPD. The goal is to avoid invasive ventilation. However, if the patient’s condition worsens, intubation and conventional mechanical ventilation would be indicated.

Types of COPD

There are two primary types of COPD:

1. Emphysema
2. Chronic bronchitis

Each has key similarities and differences that must be understood by respiratory therapists and medical professionals.

Emphysema

Emphysema is an obstructive disease that results in increased lung expansion due to air trapping. It causes irreversible damage to the alveolar walls which causes permanent enlargement of the air spaces distal to the terminal bronchioles.

This makes it difficult for a person to exhale air out of the lungs.

Chronic bronchitis

Chronic bronchitis is a type of COPD that is characterized by increased mucus production in the trachea and bronchi. This results in a productive cough that occurs for at least three months of the year for more than two consecutive years.

COPD Practice Questions:

1. What is chronic obstructive pulmonary disease (COPD)?
It stands for Chronic Obstructive Pulmonary Disease. It is a lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible. The more familiar terms ‘chronic bronchitis’ and ’emphysema’ are no longer used, but are now included within the COPD diagnosis.

2. What is the most common cause of chronic obstructive pulmonary disease?
Smoking

3. What are some other causes of chronic obstructive pulmonary disease?
Long term work environments that is smoky or dusty.

4. When can be the onset of chronic obstructive pulmonary disease?
Symptoms of chronic obstructive pulmonary disease can first appear up to 20 years. Ambulance attendance is often triggered by a respiratory infection.

5. What are four diseases that are considered chronic obstructive pulmonary diseases?
Emphysema, chronic bronchitis, refractory asthma and some forms of bronchiectasis

6. What is the effect on airflow in terms of chronic obstructive pulmonary disease?
Obstruction and/or limitation that is not completely reversible.

7. What are the causes of chronic obstructive pulmonary disease?
Chronic inflammatory responses, noxious particles and gases

8. What is the progressive nature of chronic obstructive pulmonary disease and why is it important to establish a baseline and follow up?
Chronic obstructive pulmonary disease will get worse over a progressive period of time. It is pertinent to establish a baseline in order to start treatment and follow-up to track the progression of this disease.

9. What is the etiology of chronic obstructive pulmonary disease and lung damage risk factors?
Smoking, genes, age and gender, lung growth and development, exposure to particles, social status and deficiency of serine protease inhibitor alpha 1 anti-trypsin (AAT).

10. What is the general pathophysiology of COPD?
Airflow limitation and air trapping; traps air in exhalation leading to hyperinflation; and breaks down of the alveolar walls, excess mucus inflamed lining and bronchial.

11. What are the general symptoms of COPD?
Dyspnea, cough, sputum, fever, wheezing, chest tightness, and fatigue.

12. What are the differences on the major symptoms between chronic bronchitis and emphysema?
In chronic bronchitis, symptoms consist of excessive sputum production for at least 3 months for a year and twice in a row while emphysema’s symptoms consist of the destruction of the gas exchange surfaces.

13. What are two major ways to diagnose COPD?
Clinical assessment/history and Spirometer to measure volumes, capacities, and flow of air.

14. What are other ways to diagnose chronic obstructive pulmonary disease?
Laboratory values, electrocardiogram (EKG), arterial blood gas (ABG) and chest x-ray (CXR)

15. What are the COPD severity staging guidelines?
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging systems are: Stage 1 or Mild COPD, patients with FEV1 (forced expiratory volume in one second) <80% of predicted. Patients experience shortness of breath when hurrying on the level or walking up a slight hill; Stage 2 or Moderate COPD, patients with FEV1=50-80% of predicted. Patients experience shortness of breath causing patient to stop after walking about 100 meters on level ground; Stage 3 or Severe COPD, patients with FEV1=30-50% of predicted. Patients experience shortness of breath to leave the house or breathless after dressing or undressing and present chronic respiratory failure or clinical signs of heart failure; and, Stage 4 or Very Severe COPD, patients with FEV1 <30% of predicted. Death is imminent.

16. What are the main interventions for managing chronic obstructive pulmonary disease?
Removing irritant like smoking cessation, pharmacology agents, pulmonary rehabilitation and surgical options

17. What is the effect of bronchodilators on the decline in lung function?
Drugs don’t change the progressive decline in lung function. They will only help dilate the bronchotracheal tree to help aide air movement and mucus movement.

18. What are the main goals of drugs in COPD management?
They are designed to improve symptoms and improve the quality of life for the patient.

19. What medications are used in the management of COPD?
These are racemic epinephrine, Albuterol/Proventil (ventilin), Levalbuterol (xopenex), Salmeterol, Formoterol, Arformoterol (brovana), Ipratropium (atrovent), Tiotropium (sprivia), Budesonide (pulimcort), Mometasone (asmanex), Fluticasone (Flovent), Beclomethasone (QVAR), Acetylcysteine (mucomyst), and Dornase alpha (rhDNAse), and Nedocromil (tilade).

20. What is the preferred long-term steroid administration route and why is it preferred?
It is inhaled administration route because they don’t have the side effects of systemic steroids.

21. When is it appropriate to use systemic steroids?
The appropriate use of systemic steroids is when nothing else works. Symptoms and airflow limitation increase despite maximal therapy with other drugs. Systemic steroids can be administered by IV (intravenous), shot, or orally.

22. What are the criteria for home oxygen use?
PaO2<55% or SaO2 <88% on room air taken 2 times over 3 weeks period in stable patient and PaO2 55-60% if evidence of pulmonary hypertension (HTN), congestive heart failure (CHF), or polycythemia.

23. What is chronic bronchitis?
Chronic bronchitis is an increase production of mucus from bronchi. It is not from a specific disease. Common characteristic of this disease is the present of cough and increase sputum for 3 consecutive months each year for 2 years.

24. What are the three causes of chronic bronchitis?
Smoking, recurring pulmonary infections as a child may increases susceptibility and air pollution

25. What is the pathophysiology of chronic bronchitis?
Inhale irritant, bronchial walls inflame and bronchial mucous glands enlarged

26. What are the advanced stages of chronic bronchitis?
Larger airways plug, V/Q (ventilation/perfusion) mismatch, pulmonary arteries constrict and polycythemia

27. What can be observed on the result of a complete blood count (CBC) of patients with advanced stage of chronic bronchitis?
For male, RBC (red blood cell) 4.6-6.2 million/UL with Hgb 13-18 gm/dl and for female, RBC 4.2-5.4 million/UL with Hgb12-16 gm/dl

28. What are the clinical manifestations of chronic bronchitis?
Frequent cough with mucous expectorate, slight increase on respiratory rate (RR), and slight increase of heart rate (H), carbon dioxide (CO), blood pressure (BP), dyspnea only with lung infection. Breath sounds and x-ray have no significant changes. The arterial blood gas (ABG) has slight respiratory alkalosis with mild hypoxemia (↑PH, ↓PaCO2, ↓HCO3 ↓PaO2). Advanced signs of chronic bronchitis includes a chronic cough with increased mucus, increased respiratory rate (RR), heart rate (HR), carbon dioxide (CO), blood pressure (BP), dyspnea especially with exertion, increased work of breathing (WOB) with prolonged expiration, diagnostic palpation/percussion, decreased tactile and vocal fremitus, hyper resonant percussion note in breath sounds, and decreased conditioned reflex (Cr).

29. What are the diagnostic test and result of chronic bronchitis?
Chest x-ray (CXR) shows hyperinflation or air trapping, translucent or very dark, increased A-P diameter (barrel chest), flattened Diaphragm or blunted costophrenic angle, spider like projection in the bronchogram, and enlarged heart. Pulmonary function testing shows decreased expiratory maneuver, forced vital capacity (FVC) of lung volume and capacity is increased along with ventricular tachycardia (Vt), right ventricle (RV), residual volume/total lung volume (RV/TLC) and functional residual capacity (FRC). There is a decrease in vital capacity (VC), inspiratory reserve volume (IRV), expiratory reserve volume (ERV), and a normal forced expiratory volume in one second (FEV1) and forced vital capacity (FVC 78) that is 83% if less than 50% significant disease.

30. What are available treatments for medical and respiratory of chronic bronchitis?
Stop smoking to eliminate irritant. Avoid other lung infections. Avoid dry and cold air. Improve bronchial hygiene by humidifying oxygen (O2) when necessary. Dilate airway to help a cough with the use of bronchodilator that is sympathomimetic and administration of parasympatholytic agent like Beta 2-Parasympatholytic, xanthine, and theophylline that aids bronchial dilation. For treatment of thin and thick mucus, use of mucolytic, percussion and postural drainage (P&PD), ultrasonic nebulizer (usn) and heated aerosol. Antibiotics are for bacterial treatment.

31. What are the changes in breath sounds in early chronic bronchitis?
No significant changes.

32. What will the arterial blood gas (ABG) show for patients diagnosed with early stages of chronic bronchitis?
Arterial blood gas (ABG) will have a slight respiratory alkalosis with mild hypoxemia (↑PH, ↓PaCO2, ↓HCO3 ↓PaO2).

33. What is the breath sounds in advanced chronic bronchitis?
Crackles with wet secretions wheezes that leads to bronchoconstriction (mucus plug) and Rhinflamedflammed airways.

34. What will the arterial blood gas (ABG) show for patients diagnosed with the advanced stage of chronic bronchitis?
It will show Compensated Respiratory Acidosis (pH normal,↓ PaO2 (cyanosis & clubbing),↑ PaCO2, ↑ HCO3).

35. Why do the pulmonary vessels constrict during chronic bronchitis?
Constriction happens because of hypoxemia leading to pulmonary vascular resistance (PVR).

36. What is the method of medicine delivery that requires patients to keep track of how many doses they have used?
Metered-dose inhaler

37. What is the difference between chronic obstructive pulmonary disease and asthma?
Chronic obstructive pulmonary disease (COPD) is not reversible and asthma is.

38. What is the main risk factor for chronic obstructive pulmonary disease?
Smoking

39. What is hypercapnia?
Above normal PaCO2

40. When should a hospice referral be made for a COPD patient?
When the disease enters Stage III-IV

41. What is the most common test in diagnosing and monitoring chronic obstructive pulmonary disease (COPD)?
Spirometry

42. What is the best care approach suited for chronic obstructive pulmonary disease?
Palliative care and home health

43. What organs do patients of chronic obstructive pulmonary disease develop complication in general?
The diaphragm and the throat

44. What triggers exacerbation for chronic obstructive pulmonary disease?
Infection, pollution, and cold weather

45. When can an advance directive become effective?
When the patient’s condition is determined to be non-reversible with no hope of recovery, and the patient is no longer able to speak for her. It is signed by two doctors.

46. What contributes most to chronic obstructive pulmonary disease?
The number of pack-years that the patient smoked.

47. What does FEV1 stand for?
Forced Expiratory Volume in the first second.

48. What characteristic is in chronic obstructive pulmonary disease?
This disease involves abnormal inflammation.

49. How many times is a smoker more likely to die of chronic obstructive pulmonary disease than a non-smoker?
10 times

50. What are bronchodilators?
It is the medication that relaxes the smooth muscles of the airways and makes breathing easier.

51. What heart problem is caused by chronic obstructive pulmonary disease?
Cor pulmonale

52. What is a noninvasive type of ventilation?
Noninvasive positive-pressure ventilation or NPPV

53. What may signal the existence of asthma?
Bronchodilator reversibility, chronic bronchitis, and emphysema

54. What device must be surgically implanted?
Transtracheal catheter

55. What is not a benefit of long-term oxygen therapy?
Better absorption of medications and better mental functioning

56. What common misconceptions about chronic obstructive pulmonary disease?
Lower respiratory infections usually increase once a patient quits smoking. Because COPD causes wasting, weight gain resulting from smoking cessation is not much of a problem.

57. Why is diaphragmatic breathing not usually recommended for patients with chronic obstructive pulmonary disease?
Diaphragmatic breathing or deep breathing is done by contracting the diaphragm. Patients suffering from chronic obstructive pulmonary disease relay more on the accessory muscle of the neck, shoulders and back to breathe rather than the diaphragm. This technique is more difficult to master and little proof has been found that it has positive effects.

58. What nail finding is commonly seen with chronic obstructive pulmonary disease?
Clubbed fingers

59. What type of chronic obstructive pulmonary disease is referred as a “pink puffer”?
Emphysema

60. What type of chronic obstructive pulmonary disease is referred as a “blue bloater”?
Chronic bronchitis

61. What type of chronic obstructive pulmonary disease presents more commonly with a cough and sputum?
Chronic bronchitis

62. What type of chronic obstructive pulmonary disease will complain most often of dyspnea?
Emphysema

63. What type of chronic obstructive pulmonary disease is common in a younger population (late 30s and 40s)?
Chronic bronchitis

64. What type of chronic obstructive pulmonary disease produces peripheral edema?
Chronic bronchitis

65. What type of COPD has “quiet” breath sounds without adventitious sounds on auscultation?
Emphysema

66. What are the characteristics of chronic bronchitis?
Chronic bronchitis is characterized by a productive cough that lasts at least three months with recurring bouts occurring for at least two consecutive years, copious amounts of mucus production, airway obstruction due to bronchial inflammation and destruction of the pulmonary acini.

67. Which is more prevalent, asthma or COPD?
Asthma is more prevalent but chronic obstructive pulmonary disease is more deadly.

68. What are the physical findings of chronic obstructive pulmonary disease?
Barrel chest, cyanosis of mucosal membranes, increased resting respiratory rate, shallow breathing, and pursed lips during respiration

69. What is the greatest risk of chronic obstructive pulmonary disease?
Patients with COPD are at risk of a right-sided heart failure. A patient with a myocardial infarction (MI) is at risk for left-sided heart failure.

70. What are the three primary symptoms of COPD?
Cough, sputum production, and dyspnea on exertion.

71. What are the potential complications of chronic obstructive pulmonary disease?
Polycythemia (elevated RBC (red blood cell)), infection, atelectasis, pneumonia, pulmonary hypertension and respiratory insufficiency or failure. 

72. Who should undergo spirometry testing to detect chronic obstructive pulmonary disease?
Smokers or ex-smokers 40 years of age and older who have the symptoms.

73. What will the Spirometry show for chronic obstructive pulmonary disease?
There will be reductions in force expiratory volume in the first second (FEV1), strong predictor of mortality rate; FEV1/FVC (forced vital capacity) and mid-expiratory flow rate

74. What are the available treatments for chronic obstructive pulmonary disease?
Smoking cessation, oxygen therapy, pharmacological therapy, and pulmonary rehabilitation.

FAQ

What Does COPD Stand for?

COPD stands for “chronic obstructive pulmonary disease.” It’s a group of disorders that obstructs the airways and makes it difficult to breathe.

What is the Medical Definition of COPD?

COPD a chronic disease that causes progressive airway obstruction and results in breathing-related problems. It affects people of all ages but is most common in adults over the age of 40.

What is an Acute Exacerbation of COPD?

An acute exacerbation of COPD is a worsening state of the disease that usually indicates the patient is in need of increased medication dosages or other forms of care.

What are the 4 Stages of COPD?

The four stages of COPD include the following:

1. Mild
2. Moderate
3. Severe
4. Very severe

Each stage is based on the patient’s spirometry results, which involves measuring the amount of air the person can exhale in one second (FEV1).

How Fast Does COPD Progress?

COPD is a progressive disease, meaning it gets worse over time. The rate at which it progresses varies from person to person, but on average, it’s about 1–2% per year.

However, there are many factors that can affect the rate of progression, such as smoking status, air pollution, and genetics.

What is the Normal Oxygen Level for Someone with COPD?

The normal oxygen level for healthy individuals is between 95-100%. However, COPD patients usually maintain lower oxygen levels between 88-92%. If their oxygen levels drop below 88%, the patient can be treated with low-flow supplemental oxygen therapy.

What is the Best Oxygen Flow Rate for a Person with COPD?

Low-flow oxygen therapy is often used to treat patients with COPD if their oxygen levels are decreased. In general, 2-3 L/min is often recommended. However, if the patient continues to show signs of hypoxemia, the flow rate may be increased.

Noninvasive ventilation may be indicated to provide higher levels of oxygen. And in severe cases, the patient may require intubation and mechanical ventilation.

What is the Normal Heart Rate for a COPD Patient?

The normal heart rate for COPD patients is usually between 60-100 bpm. However, tachycardia (heart rate > 100 bpm) is common in COPD patients due to the increased workload on the heart.

Bradycardia (heart rate < 60 bpm) can also occur in COPD patients, particularly those with a severe obstruction.

Why Do COPD Patients Have Lower Oxygen Saturations?

COPD patients often have lower oxygen saturations because their lungs are not able to exchange oxygen as efficiently.

This is due to the obstruction of airways and damage to alveoli. As a result, less oxygen is available for diffusion into the blood.

What Triggers COPD Attacks?

Smoking is the most common trigger for COPD attacks. However, they can also be triggered by a number of things, such as cold weather, upper respiratory infections, and air pollution.

Why is COPD Worse at Night?

COPD is often worse at night because, when a person is lying down, gravity is no longer helping to keep the airways open. Additionally, many people with COPD have difficulty sleeping, which can make symptoms worse over time.

What is the Best Climate for COPD?

There is no definitive answer to this question as different people with COPD will have different preferences.

However, in general, a climate that is warm and humid is often best for COPD patients. This is because cold, dry air can worsen symptoms like shortness of breath and coughing.

When to Go to Hospital with COPD?

If you are experiencing a sudden worsening of COPD symptoms, it is important to seek medical help. This is because an exacerbation can quickly become life-threatening.

Symptoms that require immediate medical attention include shortness of breath that is not relieved by medications, chest pain, and bluish lips or skin.

Final Thoughts

COPD is a disease that has impacted the world and will continue to do so for years to come. This why it’s important for respiratory therapists to be well-informed about this disorder, including the symptoms, causes, and treatment methods.

If you enjoyed this article, we have a similar guide on the other obstructive diseases that I think you’ll find helpful. Thank you so much for reading and, as always, breathe easy, my friend.