Chronic Obstructive Pulmonary Disease (COPD)

Question 1

What is COPD?

Answer 1

• Airflow obstruction
• Progressive
• Not fully reversible
  Hyperinflation - Emphysema

Question 2

Symptoms in COPD

Answer 2

• Breathlessness

- Cough and recurrent chest infection

Question 3

What is the main reason people develop COPD?

Answer 3

Smoking - tobacco

Question 4

What other effect can COPD have on the body apart from respiratory?

Answer 4

• Loss of muscle mass
• Weight loss
• Cardiac disease
• Depression, anxiety etc

Question 5

How do you diagnose COPD?

Answer 5

• Relevant history (symptoms)
• Look for clinical signs
• Confirmation of diagnosis and assessment of severity
• Other relevant tests e.g. spirometry

Question 6

Symptoms smokers may have for COPD

Answer 6

• Chronic cough
• Exertional breathlessness
• Sputum production
• Frequent “winter” bronchitis
• Wheeze/chest tightness

COPD mainly >35 years old

Question 7

Examinations of COPD

Answer 7

• May be normal in early stages
• Reduced chest expansion
• Prolonged expiration/Wheeze
• Hyperinflated chest
• Respiratory failure: tachypneoa, cyanosis, use of accessory muscles, pursed lip breathing, peripheral oedema.

Question 8

What FEV1 indicates COPD severity?

Answer 8

• > 80% predicted (mild)
• 50-79% predicted (moderate)
• 30-49% predicted (severe)
• <30% predicted (very severe)

Question 9

Baseline tests for COPD

Answer 9

• Spirometry: record absolute and % predicted value
• Chest Xray
• ECG
• Full blood count (anaemic/ polycythaemic/ eosinophilia)
• BMI
• AIAT

Question 10

Aims of COPD management

Answer 10

• Prevention of disease progression
• Relieve breathlessness
• Prevention of exacerbation
• Management of complications

Question 11

Intervention methods for COPD management

Answer 11

• Smoking cessation
• Inhalers
• Inhalers, vaccines, pulmonary rehabilitation (PR)
• Long term oxygen therapy

Question 12

What are non-pharmacological management methods for COPD?

Answer 12

• Smoking cessation
• Vaccinations: annual flu vaccine, pneumococcal vaccine
• Pulmonary rehabilitation (PR)
• Nutritional assessment
• Psychological support

Question 13

Benefits of pharmacological management of COPD

Answer 13

• Relieves symptoms
• Prevent exacerbations
• Improve quality of life

Question 14

Inhaled therapy - Short acting bronchodilators

Answer 14

• SABA (e.g. salbutamol)

- SAMA (e.g. ipratropium)

Question 15

Inhaled therapy - Long acting bronchodilators

Answer 15

• LAMA (long acting anti-muscarinic agents e.g. umeclidinium, tioptropium)
• LABA (long acting B2 agonist e.g. salmeterol)

Question 16

Inhaled therapy - High dose inhaled corticosteroids (ICS) and LABA

Answer 16

• Relvar (fluticasone/vilanterol)

- Fostair MDI

Question 17

When is Long term oxygen (LTOT) used for COPD?

Answer 17

when PaO2 <7.3 kPa

or PaO2 7.3-8kPa if:

• polycythaemia
• nocturnal hypoxia
• peripheral oedema
• pulmonary hypertension

Question 18

COPD - Exacerbation (AECOPD) symptoms

Answer 18

• Increasing breathlessness
• Cough
• Sputum volume
• Sputum purulence
• Wheeze
• Chest tightness

Question 19

AECOPD - OP management methods

Answer 19

• Short acting bronchodilators: salbutamol and/or ipratropium, nebulisers if cannot use inhalers
• Steroids: prednisolone 40mg a day for 5-7 days
• Antibiotics: if there is evidence of infection
• Consider hospital admission if unwell: tachypneoa, low oxygen saturation, hypotensions.

Question 20

AECOPD investigations required in patients admitted to hospital

Answer 20

• Full blood count
• Biochemistry and glucose
• Theophylline concentration
• Arterial blood gas
• Electrocardiograph
• Chest Xray
• Blood cultures in febrile patients
• Sputum microscopy, culture and sensitivity

Question 21

AECOPD - ward based management methods

Answer 21

• Oxygen-target saturation 88-92%
• Nebulised bronchodilators
• Corticosteroids
• Antibiotics (Oral vs IV)
• Assess for evidence of respiratory failure

Question 22

AECOPD - acute respiratory failure method

Answer 22

Non-invasive ventilation (NIV)