CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Question 1

WHAT IS THE PATHOPHYSIOLOGY OF COPD?

Answer 1

• Progressive airflow obstruction that is not fully reversible
• Made up of:
  1) EMPHYSEMA - elastin destruction in terminal bronchioles, enlargement of distal air spaces, reduce surface area for gas exchange
  2) CHROMIC BONCHITIS - large airway inflammation lead to loss of cilia function and mucus hypersecretion causing lumen obstruction.

Question 2

WHAT ARE THE SYMPTOMS OF COPD?

Answer 2

1) chronic cough
2) wheeze
3) dyspnoea
4) sputum production

Question 3

WHAT ARE THE SIGNS OF COPD?

Answer 3

1) Use of accessory muscles of respiration- SCM
2) Purse lip breathing
3) Barrell chest
4) Cyanosis
5) Reduce bilateral chest expansion
6) Tachypnoea
7) Peripheral oedema
8) Percussion - hyper-resonant
9) Auscultation - wheeze, reduce breath sounds

Question 4

WHAT ARE THE CAUSES OF COPD?

Answer 4

1) Smoking
2) Alpha-1- antitrypsin deficiency
3) Industrial exposure- asbestos

Question 5

WHAT INVESTIGATIONS ARE THERE FOR COPD?

Answer 5

1) Spirometry - obstructive / FEV1:FVC < 70%
2) Pulse oximetry
3) ABG - low PaO2 +/- hypercapnia, look for respiratory failure
4) CXR - hyperinflated lung (>6 anterior rib above diaphragm), flattened diaphragm
5) FBC - anaemia
6) ECG - risk factors of COPD similar to ischaemic heart disease

Question 6

WHAT ARE THE LIFESTYLE MANAGEMENT OF COPD?

Answer 6

1) Smoking cessation
2) Pulmonary rehabilitation - 6-12 week programme of supervised exercise, nutrition advice
3) Diet

Question 7

WHAT IS THE PHARMACOLOGICAL MANAGMENT OF COPD?

Answer 7

1) Initial management - SABA/ SAMA
2) Step up for continued breathless/ exacerbations without asthmatic features or steroid response - LABA + LAMA, discontinue SAMA and give SABA as required. Continues exacerbations give triple therapy of LABA + LAMA + ICS
3) Step up for continues breathless/ exacerbation with asthmatic features or steroid response- LABA + ICS, continues exacerbation give triple therapy of LABA + LAMA + ICS
4) Vaccinations- pneumococcal + influenza
5) Mucolytic
6) LTOT- continuous O2 therapy due to risk of cardiac and renal damage
7) Diuretics

Question 8

WHAT IS A COPD EXACERBATION AND ITS CAUSES?

Answer 8

• Sustained worsening of symptoms from patients stable state

- Causes- infective or non- infective

Question 9

WHAT ARE THE FEATURES OF COPD EXACERBATIONS?

Answer 9

• Worsening breathlessness, chronic cough
• Sputum- increase volume, change in colour, purulence
• Fever

Question 10

WHAT INVESTIGATION ARE THERE FOR COPD EXACERBATION?

Answer 10

• ABG- look for respiratory failure
• Sputum culture
• ECG
• Blood tests- FBC (raised WCC), U+E’s, CRP
• Pulse oximetry
• CXR

Question 11

WHAT IS THE MANAGEMENT OF COPD EXACERBATION?

Answer 11

1) A to E approach
2) Oxygen- fixed performance mask, aim for 88-92%SATS
3) Nebulised salbutamol and ipratropium bromide
4) Steroids- prednisolone 30mg STAT
5) Antibiotics- raised WCC, CRP or purulent sputum
7) IV aminophylline - if bronchodilators don’t work
6) NIV (non invasive ventilation) if type 2 RF

Question 12

COMMON CAUSATIVE ORGANISM OF COPD EXACERBATION

Answer 12

• Haemophilus influenza

- Streptococcus pneumoniae

Question 13

WHICH FIRST CHOICE ANTIBIOTICS GIVEN FOR COPD?

Answer 13

• Amoxicillin
• Doxycycline (pencillin allergy)
• Clarithromycin