Chronic Obstructive Pulmonary Disease

Question 1

Define COPD

Answer 1

Chronic progressive lung disorder characterised by irreversible airflow obstruction and
encompassing:
Emphysema – permanent destructive enlargement of air spaces distal to the
terminal bronchioles
Chronic bronchitis – chronic cough and sputum production on most days for >3
months each year for 2 consecutive years

Question 2

What are the causes/risk factors of COPD?

Answer 2

• Smoking
• Alpha-1 antitrypsin deficiency
• age
• genetic factors

Question 3

What are the presenting symptoms of COPD?

Answer 3

• Chronic cough – worse in the morning
• Sputum production
• SOB
• Wheeze
• Reduced exercise tolerance

Question 4

What are the signs of COPD?

Answer 4

• Use of accessory muscles
• Barrel shaped chest
• Hyperinflation with reduced
cricosternal distance
• Cyanosis
• Hyper-resonant chest
• Reduced breath sounds
• Prolonged expiration
• Wheeze
• Crepitations

Signs of CO2 retention
• Bounding pulse
• Warm peripheries
• CO2 flap

Signs of cor pulmonale
• Right ventricular heave
• Raised JVP
• Ankle oedema

Emphysema

• Pink
• Pursed lip breathing
• Use of accessory muscles
• Cachetic
• Hyperinflated barrel chest
• Reduced breath sounds
• Bullae -> pneumothorax

Chronic bronchitis

• Cyanotic
• Peripheral oedema
• Crackles
• Wheeze
• Obese
• secondary polycythaemia
• Pulmonary HTN
• Cor pulmonale

Question 5

What are the investigations for COPD?

Answer 5

• Bloods
- FBC – raised Hb and haematocrit (secondary polycythaemia), raised WCC (infection)
- Alpha-1 antitrypsin levels in young patients/non-smokers
• Calculate BMI
• ABG – hypoxia, normal or raised PaCO2
• Lung function tests – obstructive picture, FEV1/FVC ratio <70%, ↓ PEFR, ↑ lung
volume
• Blood/sputum culture – exclude infection
• CXR
o Hyperinflation
o Flat hemidiaphragms
o Reduced peripheral lung markings
o Elongated cardiac silhouette
• ECG/echocardiogram – exclude cor pulmonale

Question 6

What is the management for COPD?

Answer 6

Acute exacerbation
• 24% O2 with Venturi mask (aim for 88-92 % O2 sats)
• Increase dose/frequency of bronchodilator (SABA or SAMA)
• 30mg oral prednisolone for 7-14 days
• Respiratory physiotherapy to clear sputum
• Empirical antibiotics if infection
• Non-invasive ventilation if acidotic, hypercapnic, severe dyspnoea

Chronic
• Smoking cessation
• Influenza vaccination yearly and pneumococcal vaccination every 5 years
• Pulmonary rehabilitation
• Long-term oxygen therapy (LTOT)
- PaO2 <7.3kPa
- PaO2 7.3-8.0kPa and signs of secondary polycythaemia, nocturnal hypoxaemia,
peripheral oedema or pulmonary HTN

Question 7

What are some complications of COPD?

Answer 7

• Depression
• Acute respiratory failure
• Infections e.g. Streptococcus pneumoniae,
Haemophilus influenzae
• Pulmonary hypertension -> cor pulmonale
• secondary pneumothorax
• secondary polycythaemia