Chronic obstructive pulmonary disease

Question 1

What is COPD?

Answer 1

Chronic pulmonary disease characterized by persistent respiratory symptoms and airflow limitation (postbronchodilator FEV1/FVC < 0.70), which is caused by a mixture of small airway obstruction and parenchymal destruction

Question 2

What is chronic bronchitis?

Answer 2

productive cough (cough with expectoration) for at least 3 months each year for 2 consecutive years

Question 3

What is emphysema?

Answer 3

permanent dilatation of pulmonary air spaces distal to the terminal bronchioles, caused by the destruction of the alveolar walls and the pulmonary capillaries required for gas exchange

Question 4

What are the causes of COPD?

Answer 4

Tobacco use (90% of cases)
Exposure to air pollution or fine dusts
α1-Antitrypsin deficiency

Question 5

What is the classification for COPD?

Answer 5

(FEV1 criteria) > 80% Stage 1 - Mild*
50-79% Stage 2 - Moderate
30-49% Stage 3 - Severe
< 30% Stage 4 - Very severe

Question 6

What are the clinical features of COPD?

Answer 6

Chronic productive cough typically occurs in the morning
Dyspnea and tachypnea
Cyanosis
Congested neck veins
Barrel chest
(Pink puffer) In emphysema, Noncyanotic, Cachectic (weakness), Pursed-lip breathing, Mild cough
(Blue bloater) Chronic bronchitis, Productive cough, Overweight, Peripheral edema

Question 7

How is COPD diagnosed?

Answer 7

(post-bronchodilator spirometry) Positive when PFEV1/FVC ratio less than 70%
(chest x-ray) hyperinflation, bullae, flat hemidiaphragm
(α1-Antitrypsin levels) In patients <50 yrs or unexplained liver disease

Question 8

What is the treatment for stable COPD?

Answer 8

(General management) Smoking cessation
annual influenza vaccination
one-off pneumococcal vaccination
pulmonary rehabilitation

(Bronchodilator therapy) a short-acting beta2-agonist (SABA) or short-acting muscarinic antagonist (SAMA) is first-line treatment
(If unresponsive) add a long-acting beta2-agonist (LABA) + long-acting muscarinic antagonist (LAMA)

(In asthma or steroid responsive patients) LABA + inhaled corticosteroid (ICS)
(Oral theophylline) For those who had no response still
(Oral prophylactic antibiotic therapy)
(Loop diuretic + oxygen therapy) For those with cor pulmonale

Question 9

What are the indications for long-term oxygen therapy?

Answer 9

LTOT to patients with a pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following:
secondary polycythaemia (abnormally high haemoglobin count)
peripheral oedema
pulmonary hypertension

Question 10

What are the clinical features for acute exacerbations of COPD?

Answer 10

dyspnoea, cough, wheeze
increased sputum production
signs of hypoxia (i.e. confusion)

Question 11

What are the causes of COPD exacerbation?

Answer 11

(Most common) Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae

Congestive heart failure
Pulmonary embolism

Question 12

What is the treatment for COPD exacerbation?

Answer 12

(Increase frequency of bronchodilator use + possibly nebuliser use)
(Prednisolone 30 mg daily for 7-14 days)
(Antibiotics: amoxicillin or clarithromycin or doxycycline.) If signs of infection (e.g. purulent sputum)