Chronic Obstructive Pulmonary Disease

Question 1

What is COPD?

Answer 1

COPD is a progressive lung disease characterised by airflow limitation that is not fully reversible. The airflow limitation is associated with an abnormal inflammatory response of the lungs to noxious particles or gases. There are 3 disease processes associated with COPD:

1. Chronic bronchitis
2. Emphysema
3. Chronic asthma

An acute exacerbation of COPD is characterised by a change in a patient’s baseline dyspnoea, cough or sputum production (typically due to respiratory infections).

Question 2

Clinical features of COPD and acute exacerbations?

Answer 2

1. Breathlessness on exertion
2. Cough & sputum production
3. Chest tightness
4. Wheeze
5. Malnutrition & obesity
6. Polypharmacy
7. Older age

Signs of advanced disease:

1. Dynamic chest hyperinflation
2. Soft breath sounds, prolonged expiratory phase
3. Hypoxia & hypercapnia
4. Inactivity, poor appetite & weight loss
5. History of 02 therapy

AECOPD:

1. Difficulty speaking, anxiety, tachypnoea, tachycardia & cyanosis
2. Accessory muscle use, tracheal tug, intercostal recessions, paradoxical abdominal wall movement

Question 3

What are potential differential diagnoses for COPD?

Answer 3

1. Heart failure & cardiogenic APO
2. IHD & AMI
3. PE
4. Pneumothorax
5. Pleural effusion, pneumonia & lobar atelectasis
6. Upper airway obstruction
7. Anaphylaxis

Question 4

How is COPD treated?

Answer 4

If there is no evidence of severe respiratory distress:

1. O2 - maintain SP02 at 88-92%
2. Salbutamol (NEB)
3. Ipratropium bromide (NEB)
4. Hydrocortisone (IM/IV)

If there is evidence of severe respiratory distress:

1. Minimise patient exertion
2. Provide reassurance
3. O2 - maintain SP02 at 88-92%
4. Salbutamol (NEB)
5. Ipratropium bromide (NEB)
6. Hydrocortisone (IM/IV)
7. Adrenaline (IM)
8. IPPV (+/- PEEP)