Chronic Obstructive Pulmonary Disease

Question 1

What is COPD?

Answer 1

• Airway obstruction that is not entirely reversible.
  
  • Chronic bronchitis (3 months productive cough in 2 years)
  • Obstructive bronchiolitis (small airway destruction and fibrosis)
  • Emphysema (distal airway destruction (non-fibrotic) and termiinal air space enlargement)

Question 2

Outline the pathophysiology of COPD

Answer 2

• Noxious agents cause neutrophilic/CD8/macrophagic inflammation
  
  • Parenchymal destruction and loss of elasticity
  • Smal airway remodelling
  • Lowered gas-exchange area
• Consequences
  
  • Mucus production
  • Fibrosis and proteolysis
  • Vascular disease (cor pulmonale)

Question 3

What are the risk factors for COPD?

Answer 3

• Smoking
• Pollution/indoor fires
• Chronic respiratory infections
• Genetics (a1 antitrypsin deficiency, atopy)
• Premature birth

Question 4

How is a person with chronic bronchitis likely to present?

Answer 4

• “Blue bloater”
  
  • Chronic productive cough
  • Purulent sputum/haemoptysis
  • Mild dyspnoea
  • Cyanosis
  • Peripheral oedema (cor pulmonale)
  • Crackles/wheezes/prolonged expiration

Question 5

How is a person with emphysema likely to present?

Answer 5

• “Pink puffer”
  
  • Dyspnoea
  • Minimal cough
  • Tachypnoea/pursed-lip/accessory use
  • Pink skin
  • Hyperinfated chest
  • Decreased breath sounds

Question 6

How is a person with an acute COPD exacerbation likely to present?

Answer 6

Increased dyspnoea, sputum discolouration and/or increased production

Question 7

What is the BODE index?

Answer 7

• A score used to denote prognosis in COPD
  
  • BMI
  • Obstruction (FEV1)
  • Dyspnoea (MRC scale)
  • Exertional dyspnoea (6 min walk test)

Question 8

What are the principles of management for a patient with COPD?

Answer 8

1. SABA/SAMA as required, vaccination (flu, pneumococcus if over 65y), smoking cessation
2. LABA/LAMA, pulmonary rehab
3. ICS +/- PDE-4 inhibitor/theophylline
4. Oxygen, lung transplantation, palliation (e.g. low-dose oral morphine/benzodiazepines)

Question 9

What can precipitate an exacerbation of COPD?

Answer 9

• Respiratory infections
• Heart failure/arrhythmias
• Systemic infection/fever
• Anaemia
• Raised metabolic rate

Question 10

What are the principles of management for a patient with an acute COPD exacerbation?

Answer 10

• SABA/SAMA, systemic glucocorticoids, O2 if hypoxic
• Narrow spec ABs if low-risk/not severe (amoxy or doxy or trimethoprim/sulfamethoxazole)
• Broad spec ABs if high-risk/hospitalisation required (cefuroxime or amoxyclav, or tri/sulf +/- Pseudomonas coverage)