Chronic obstructive pulmonary disease (COPD)

Question 1

Define chronic obstructive pulmonary disease (COPD).

Answer 1

COPD is characterised by airflow limitation that is not fully reversible. It encompasses both emphysema and chronic bronchitis.

Question 2

Explain the aetiology/risk factors of chronic obstructive pulmonary disease (COPD).

Answer 2

Tobacco smoking is by far the main risk factor for COPD. It is responsible for 40% to 70% of COPD cases and exerts its effect by causing an inflammatory response, cilia dysfunction, and oxidative injury. Air pollution and occupational exposure are other common aetiologies.
Oxidative stress and an imbalance in proteases and antiproteases are also important factors in the pathogenesis of COPD, especially in patients with alpha-1 antitrypsin deficiency, who have panacinar emphysema that usually presents at an early age.

Question 3

Summarise the epidemiology of chronic obstructive pulmonary disease (COPD).

Answer 3

COPD is more common in older people, especially those aged 65 years and older. A retrospective study conducted in the UK between 1990 and 1997 estimated COPD prevalence to be 2% in men and 1% in women.

Question 4

Recognise the presenting symptoms of chronic obstructive pulmonary disease (COPD).

Answer 4

Cough
Shortness of breath

Question 5

Recognise the signs of chronic obstructive pulmonary disease (COPD) on physical examination.

Answer 5

Barrel chest

Hyperresonance on percussion

Distant breath sounds on auscultation

Poor air movement on auscultation

Wheezing on auscultation

Coarse crackles

Question 6

Identify appropriate investigations for chronic obstructive pulmonary disease (COPD) and interpret the results.

Answer 6

Spirometry
Pulse oximetry
ABG
CXR
FBC
ECG

Question 7

Generate a management plan for chronic obstructive pulmonary disease (COPD).

Answer 7

Short-acting bronchodilator

Adjunct:
Systemic corticosteroid
Transition to inhaled corticosteroid
Airway clearance techniques
Supplemental oxygen

Question 8

Identify the possible complications of chronic obstructive pulmonary disease (COPD) and its management.

Answer 8

Cor pulmonale - Right-sided heart failure secondary to long-standing COPD. It is caused by chronic hypoxia and subsequent vasoconstriction in pulmonary vasculature that causes pulmonary hypertension and right-sided heart failure.
Recurrent pneumonia
Depression
Pneumothorax
Respiratory failure
Anaemia
Polycythaemia

Question 9

Summarise the prognosis for patients with chronic obstructive pulmonary disease (COPD).

Answer 9

COPD is a disease with an indeterminate course and variable prognosis. Its prognosis depends on several factors including genetic predisposition, environmental exposures, comorbidities, and, to a lesser degree, acute exacerbations.