Chronic Obstructive Pulmonary Disease (COPD) Flashcards
True or false: COPD is a fully reversible disease.
False.
COPD is a preventable and treatable disease state characterised by airflow limitation that is not fully reversible
(BMJ Best Practice)
True or false: COPD is the second most common lung disease in the UK, after asthma.
True.
Roughly how many people are living with diagnosed COPD in the UK?
Roughly 1.2 million people live with diagnosed COPD.
What are some of the common presenting symptoms of COPD?
- Usual presentation: progressive dyspnoea and chronic productive cough.
SoB
Wheeze
“Smokers cough”
Sputum (white/clear unless infective exacerbation)
Recurrent chest infections
History of smoking or occupational exposure
What are the causes of COPD?
Cigarette smoking
Occupational exposure
alpha-1-antitrypsin deficiency
What simple tool can be used to assess severity of dyspnoea during a history?
MRC Dyspnoea Scale
- Not troubled by breathlessness except on vigorous exertion
- Short of breath when hurrying or walking up inclines
- Walks slower than contemporaries because of breathlessness, or has to stop for breath when walking at own pace
- Stops for breath after walking about 100m or stops after a few minutes; walking on the level
- Too breathless to leave the house or breathless on dressing or undressing
Why is an ECG included among the first line investigations for COPD?
Not diagnostic, but may see signs of right ventricular hypertrophy (large P-waves), arrhythmia and/or ischaemia.
Risk factors for COPD are similar to those for ischaemic heart disease, so comorbidity is common. Right-sided heart failure may develop in longstanding COPD (cor pulmonale). (BMJ Best Practice).
Why is chest x-ray among the first line investigations for COPD?
Not diagnostic, but may show hyperinflation (flattened diaphragm, increased intercostal spaces) and rule out other pathologies.
May also show complications of COPD, such as pneumonia and pneumothorax.
How might you measure the impact of COPD on a patient’s well-being and daily life?
COPD Assessment Test (CAT)
True or false: COPD causes clubbing.
False.
How is COPD diagnosed?
Diagnosis based on clinical presentation plus SPIROMETRY.
Spirometry shows an obstructive picture. That is, their lung volume (forced vital capacity, FVC) is not as bad as their ability to quickly blow air out of their lungs (forced expiratory volume in 1 second, FEV1).
So the FEV1:FVC ratio <0.7.
FEV1 is disproportionately smaller than the FVC.
(Zero to Finals)
True or false: COPD symptoms do not show a dramatic response to reversibility testing with beta-2 agonists, such as salbutamol.
True.
If there is a large response to reversibility testing then consider asthma as an alternative diagnosis.
How is COPD managed in the long-term?
SMOKING CESSATION
Annual flu vaccine and pneumococcal vaccine.
Step 1: Short-acting bronchodilators (beta-2 agonists, salbutamol or terbutaline) or short-acting antimuscarinics (ipratropium bromide).
Step 2:
(a) Long-acting beta agnonist (LABA) + long-acting muscarinic antagonist (LAMA)
OR
(b) LABA + inhaled corticosteroid (ICS)
SABA: salbutamol
SAMA: ipratropium bromide
LABA: salmeterol, formoterol
LAMA: tiotropium
Why might a FBC be included among the first line investigations for COPD?
Chronic hypoxia may lead to polycythaemia.
Why might a FBC be included among the first line investigations for COPD?
Chronic hypoxia may lead to polycythaemia.
