Clinical aspects and therapeutics of COPD

Question 1

What are the typical symptoms of COPD and similar respiratory diseases?

Answer 1

Cough
Sputum
Wheeze
Breathlessness

Question 2

What things are very important when differentiating between these diseases when taking a history?

Answer 2

Smokers

Diurnal variation

Exacerbating factors

Family Hx

Allergies

Childhood atopy

Question 3

What characteristics point to chronic bronchitis?

Answer 3

Smokers

Purulent sputum >= 3 months for >= 2 successive years

Type 2 respiratory failure - “Blue bloaters”

Question 4

What characteristics point to emphysema?

Answer 4

Smoking history

Weight loss

Type 1 respiratory failure - “pink puffers”

Question 5

Describe the characteristics of type 1 respiratory failure?

Answer 5

“Pink puffers”

• hyperinflated chest
• increased use of accessory muscles
• decreased sternal notch
• decreased chest expansion
• intercostal recession
• paradoixcal costal margin
• decreased hepatic/cardiac dullness
• heart sounds in epigastrium
• decreased breath sounds
• polyphonic wheeze
• scanty inspiration crackles

Question 6

Describe type 2 respiratory failure

Answer 6

“Blue bloaters”

• bounding pulse
• flapping tremor
• cyanosis
• raised JVP
• ankle oedema
• tricuspid regurgitation
• large pulsatile liver

Question 7

How will emphysema appear radiologically?

Answer 7

CXR will show decreased vascular lung markings

Question 8

How is the diffusing capacity affected with emphysema?

Answer 8

Reduced due to destroyed capillary bed

Question 9

Describe the FEV1 values at different severity levels according to NICE (2010) guidelines.

Answer 9

> = 80% - stage 1: mild
50 - 79% - stage 2: moderate
30 - 49% - stage 3: severe
< 30% - stage 4: very severe

Question 10

How should COPD be managed?

Answer 10

With sensitivity - be careful using the word “emphysema”

Smoking cessation

Pharmacological methods

Pulmonary rehab

Managing acute exacerbations

Question 11

What pharmacological therapies can be used to treat COPD?

Answer 11

Bronchodilators

Inhaled corticosteroids

Mucolytics

Vaccinations

Question 12

What bronchodilators are available?

Answer 12

Beta 2 agonists

• SABA = salbutamol
• LABA = salmeterol

Muscarining-1 and muscarinic-3 antagonists

• SA =
• LA =

Question 13

What are mucolytics used for?

Answer 13

Help clear mucus

Decrease need for antibiotics

Improves cough, dyspnoea, expectoration

Question 14

Give an example of a mucolytic?

Answer 14

Carbocisteine

Question 15

How do beta 2 receptors affect bronchi?

Answer 15

Cause bronchodilation

Question 16

How do muscarinic Ach receptors affect bronchi?

Answer 16

Cause bronchoconstriction

Question 17

Give examples of beta 2 agonists available to use against COPD?

Answer 17

SABA

• Salbutamol
• Terbutaline

LABA

• Salmeterol
• Formeterol

Question 18

What are the side effects of beta-2 agonists?

Answer 18

Tremor

Hypokalaemia

Tachycardia

Question 19

Give examples of muscarinic antagonists used for bronchodilation?

Answer 19

SAMA
- Ipratropium

LAMA
- Tiotropium

Question 20

What are the side effects of Ipratropium?

Answer 20

Dry mouth

Blurred vision

GI disturbance

Can precipitate glaucoma in susceptible individuals

Question 21

What are the side effects of Tiotropium?

Answer 21

Dry mouth

Irritation by powder in inhaler

Question 22

What are the aims of pulmonary rehab?

Answer 22

Aims to break downward spiral of breathlessness and immobility

• improve QoL
• improve distance and speed of walking

Question 23

How should an acute exacerbation be managed?

Answer 23

Start corticosteroids

Antibiotic therapy available in the house