Clinical features of COPD

Question 1

What are the 2 main forms of COPD?

Answer 1

Chronic bronchitis and Emphysema

Question 2

What is 85% of COPD cases attributable to?

Answer 2

SMoking fam

Question 3

What are the other causes (15%) of COPD?

Answer 3

• Chronic asthma
• Passive smoking
• Maternal smoking, reduced FEV1 and increases respiratory illness.
• Air pollution
• Occupation
• a1-antitrypsin deficiency

Question 4

What does a1-antitrypsin do?

Answer 4

a1-antitrypsin neutralises enzymes released by neutrophils

Question 5

Symptoms of COPD

Answer 5

• Breathlesness
• Cough & sputum
• Wheeze, on exertion
• Weight loss
• Peripheral oedema

Question 6

What would you ask the patient to diagnose COPD?

Answer 6

• Past medical history
• Drugs
• Personal & social#
• Signs of COPD- e.g. breathless, cyanosis

Question 7

What essential investigations could be used to diagnose COPD?

Answer 7

• Objective demonstration of airflow obstruction by spirometry.
• Full pulmonary function testing
• Fixed airflow obstruction demonstrated by spirometry

Question 8

Features of objective demonstration of airflow obstruction by spirometry

Answer 8

• A normal FEV1 (>80%) predicted effectively rules out diagnosis.
• The lower the FEV1%
  the more severe the airflow obstruction.

Question 9

Features of full pulmonary function testing

Answer 9

• Effectively looking for emphysema.
• Checking lung volumes by gas trapping.
• Higher the residual volume, higher the lung capacity.
• OR using CO gas transfer
• Lower TLCO, lower KCO

Question 10

Read over fixed airflow obstruction by spirometry

Answer 10

DO IT

Question 11

Useful investigations for COPD

Answer 11

• Blood gases
• Full blood count
• ECG
• Sputum

Question 12

Features of blood gases investigation

Answer 12

• Lower PaO2 indicates type I respiratory failure

- Lower PaO2 but higher PaCO2 indicates type II respiratory failure.

Question 13

What can a full blood count indicate?

Answer 13

Can indicate secondary polycythaemia (hct >0.52)

Question 14

Acute exacerbations of COPD

Answer 14

Increased:

• cough
• sputum, sputum purulence
• Shortness of breath
• Wheeze
• Oedema
• Unable to sleep, confusion

Question 15

Ways to manage acute exacerbations of COPD

Answer 15

• Nebulised bronchodilator
• Beta2 & anti-muscarinic
• O2 oral/IV corticosteroid
• Antibiotic
• Diuretic IV aminophylline
• NIV
• Respiratory stimulant