12. COPD and A1AT Deficiency

Question 1

What are the causes of COPD?

Answer 1

Smoking
Biomass fuel burning, sulphur dioxide, occupational dusts
Chest infections under the age of 1
Adenovirus
HIV (increases effects of smoking)

Question 2

What are the symptoms of COPD?

Answer 2

Cough
Sputum production (greyish)
Dyspnoea
Wheeze/chest tightness

Question 3

What are the symptoms of an acute exacerbation of COPD?

Answer 3

Increase in shortness of breath and wheeze
Productive cough with change in sputum
Pleuritic pain
Ankle oedema, orthopnoea, paroxysmal noctural dyspnoea

Question 4

What is paroxysmal nocturnal dyspnoea?

Answer 4

Shortness of breath while asleep, causing patient to wake up

Question 5

What are the signs of COPD on inspection?

Answer 5

Central cyanosis
Tripod position and using accessory muscles
Pursed lip breathing
Hyperinflation

Question 6

What are the signs of COPD on percussion?

Answer 6

Hyperresonance and loss of cardiac dullness

Question 7

What are the signs of COPD on auscultation?

Answer 7

Decreased breath sounds
wheeze
Increased expiratory time

Question 8

What are the signs of CO2 retention?

Answer 8

Warm hands
Dilated veins
Asterixis

Question 9

What diseases can be included in the differential of an acute COPD exacerbation?

Answer 9

Acute congestive cardiac failure
Acute MI
PE
Pneumonia
Asthma
Mucous plugging

Question 10

What investigations should be done for management of an acute exacerbation?

Answer 10

ABG
CXR
FBCs, U&E, CRP

Question 11

What are the aims for management of an acute exacerbation of COPD?

Answer 11

Oxygenation
pH
Relieve bronchospasm
Treat infection

Question 12

What piece of equipment is used for oxygenation in COPD?

Answer 12

Venturi face mask

Question 13

What is the danger of hyperoxygenation in COPD?

Answer 13

COPD causes the patient’s body to adjust to high CO2 levels by increasing bicarb levels to keep stable
If the pH is brought too high the body’s natural drive to breathe will be cut off

Question 14

What are the options for maintaining pH during an acute exacerbation?

Answer 14

Non-invasive positive pressure ventilation with bi-level positive pressure
invasive ventilation

Question 15

Why is invasive ventilation avoided where possible?

Answer 15

Can cause a pneumothorax

Question 16

What steroids are used in acute exacerbations?

Answer 16

Hydrocortisone, with a PO switch to prednisone

Question 17

What are the options for bronchodilators in COPD?

Answer 17

Long/short acting B-agonists
Long/short acting anti-cholinergics
Methylxanthines

Question 18

What form of pulmonary rehab is used in COPD?

Answer 18

Aerobic lower extremity training: able to more easier recognise SOB and increases exercise tolerance

Question 19

What treatment should be given to a patient with severe airway obstruction that can’t be controlled by long-actiing bronchodilators?

Answer 19

Inhaled corticosteroids

Question 20

What are the complications of COPD?

Answer 20

Type 2 respiratory failure
Cor pulmonale
Recurrent chest infections
Death

Question 21

How many hours a day is long-term oxygen therapy given to a COPD patient with respiratory failure?

Answer 21

> 16

Question 22

What monitoring is needed for a patient on long term oxygen therapy?

Answer 22

CO2 and O2 confirmed twice over 3 weeks using an ABG

Question 23

What surgeries might be done on a patient with COPD?

Answer 23

Bullectomy
Lung volume reduction
Lung transplant

Question 24

What is the only recognised cause of inherited COPD?

Answer 24

a-1-antitrypsin deficiency

Question 25

What is the genotype of severe a1AT deficiency?

Answer 25

Pi ZZ

Question 26

What is the genotype of heterozygous a1AT deficiency?

Answer 26

MZ

Question 27

How is a1AT deficiency diagnosed?

Answer 27

Blood levels

Genotype

Question 28

What disease is a1AT also related to?

Answer 28

Vasculitis