Chronic Obstructive Pulmonary Disorder

Question 1

What is the definition?

Answer 1

Slowly progressive disorder characterised by airflow obstruction

Question 2

What are the aetiologies?

Answer 2

Smoking - including passive and maternal smoking
Chronic asthma 
Occupation 
Air pollution
Alpha-1-antiprotease deficiency

Question 3

What is the pathophysiology?

Answer 3

Increased numbers of mucus secreting goblet cells in the bronchial mucosa
Overly inflamed bronchi and pus in lumen
Initial inflammation occurs in the small airways
Fibrosis of bronchial walls

Question 4

What are the symptoms?

Answer 4

Productive cough with white or clear sputum
Wheeze
Breathlessness - little variation
Weight loss

Question 5

What are the signs?

Answer 5

Breathless walking into clinic
Pursed lip breathing - using accessory muscles to breath
Cyanosis
CO2 flapping tremor
Hyper expanded chest
Decreased cardiac dullness

Question 6

What are investigations?

Answer 6

SPIROMETRY
LUNG VOLUMES - gas trapping, increased residual volume, increased TLC, RV/TLC > 30%, reduced FEV1 and FEV1/FVC ratio
CARBON MONOXIDE TRANSFER - decreased TLCO and KCO
MINIMAL BRONCHODILATOR REVERSIBILITY - baseline 15 mins post neb 2.5-5mg salbutamol or baseline 30 mins post neb 2.5-5mg salbutamol and 500micrograms iprotropium
MINIMAL RESPONSE TO ICS - 30-40mg prednisolone daily for 2 weeks, measure baseline and final FEV1
CHEST XRAY - normal, hyper inflated lungs, flattened diaphragms, bull
BLOOD GAS - normal, decreased PaO2 +/- increased PaCO2
FULL BLOOD COUNT
ECG - right axis deviation, P pulmonae, T wave inversion (v1-v4)

Question 7

What are the non pharmacological management options?

Answer 7

Smoking cessation
Vaccinations
Pulmonary rehab

Question 8

What are the pharmacological management options?

Answer 8

SABA, SAMA
LABA, LAMA
High dose ICS
Long term oxygen if PaO2