Chronic Obstructive Pulmonary Disease

Question 1

COPD

Answer 1

Chronic, progressive respiratory condition characterised by obstruction, bronchitis, and emphysema.
Non-reversible.

Question 2

Chronic bronchitis

Answer 2

• characteristic feature of COPD
• chronic cough
• sputum production
• ‘blue bloater’

Question 3

Emphysema

Answer 3

• Damaged and dilatation of alveoli
• reduced elasticity and surface area
• ‘pink puffer’ purse lip breathing
• barrel chest

Question 4

Clinical features of COPD

Answer 4

• dyspnoea
• wheeze
• productive cough
• recurrent chest infections

Question 5

Gold standard investigation for COPD

Answer 5

Spirometry
- FEV1:FVC < 0.7
- +/- reduced FEV1(predicted)

Question 6

Chest x-ray findings in COPD

Answer 6

• lung hyperinflation
• flattened diaphragm

Question 7

Potential FBC findings in COPD

Answer 7

• reduced RBCs = polycythaemia

Question 8

polycythaemia

Answer 8

• low red blood cells (Hb)
• indicates chronic hypoxia
• often seen in COPD

Question 9

Determining severity of COPD

Answer 9

• Spirometry (FEV1% predicted)
• MRC dyspnoea scale (grade 1-5)

Question 10

Staging severity of COPD

FEV1 % predicted

Answer 10

Stage 1: Mild (> 80%)
Stage 2: Moderate (50-79%)
Stage 3: Severe (30-49%)
Stage 4: Very severe (< 30%)

Question 11

General management of COPD

Answer 11

• smoking cessation
• vaccinations
• pulmonary rehabilitation
• medication

Question 12

Medical management of COPD

First presentation

Answer 12

SABA (salbutamol) or SAMA (ipratropium bromide)

Question 13

Medical management of COPD

Not managed with SABA/SAMA, no asthmatic features

Answer 13

Add LABA & LAMA

Question 14

Medical management of COPD

Not managed with SABA/SAMA, asthmatic features present

Answer 14

Add LAMA & ICS

Question 15

Medical management of COPD

Not managed with SABA/SAMA, LABA/LAMA/ICS

Answer 15

Triple therapy
LABA + LAMA + ICS
Trimbow

Question 16

Medical management of COPD

Not controlled on maximum medical therapy

Answer 16

Add in prophylactic antibiotic
Azithromycin

Question 17

Complications of COPD

Answer 17

• cor pulmonale
• acute (infective) exacerbations

Question 18

Cor pulmonale

Answer 18

Right sided heart failure

Question 19

Most common causes of cor pulmonale

Answer 19

• COPD
• PE
• Interstitial lung diseases
• Cystic fibrosis
• Primary pulmonary hypertension

Question 20

Clinical features of cor pulmonale

Answer 20

• SOB
• peripheral oedema
• chest pain
• syncope

Question 21

Examination findings in cor pulmonale

Answer 21

• hypoxia, cyanosis
• raised JVP
• loud P2, parasternal heave
• hepatomegaly

Question 22

ABG findings in acute exacerbation of COPD

Answer 22

Respiratory acidosis
reduced O2, raised CO2, raised HCO3 (from chronic hypercapnia)

Question 23

Managing acute exacerbation of COPD

Answer 23

• O2 therapy (88-92%)
• Medical (inhalers, steroids, abs)
• Non-invasive ventilation

Question 24

Antibiotics used in acute exacerbation of COPD

Answer 24

• amoxicillin
• doxycyclin

Question 25

Main cause of infective exacerbation of COPD

Answer 25

Haemophillus pneumoniae