Clinical Features of COPD

Question 1

Describe the defining features and epidemiology of COPD

Answer 1

A lung disease that is characterised by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible.

Question 2

What two conditions are included in the COPD diagnosis?

Answer 2

• Chronic bronchitis: production of sputum for 3 consecutive months in at least 2 years in a row
• Emphysema

Question 3

Describe the symptoms of COPD

Answer 3

Common symptoms;

• SOB
• Recurrent chest infections
• Ongoing cough
• Wheeze
• Productive cough/sputum

Less common symptoms;

• Weight loss
• Fatigue
• Decreased exercise tolerance
• Ankle oedema (if causing HF)
• Cor pulmonale

Question 4

Explain how to assess the severity of acute COPD

Answer 4

Acute exacerbations;

• Worsening of common symptoms
• SOB (RR: >25/min)
• Accessory muscles used
• Purse lip breathing
• Cyanosis (SAT O2 >92%)
• Significant decrease in exercise tolerance
• Signs of sepsis (if exacerbation causes by infection)

Question 5

Explain how to assess the severity of acute COPD

Answer 5

Acute exacerbations;

• Worsening of common symptoms
• SOB (RR: >25/min)
• Accessory muscles used
• Purse lip breathing
• Cyanosis (SAT O2 >92%)
• Significant decrease in exercise tolerance
• Signs of sepsis (if exacerbation causes by infection)
• Fluid retention

Question 6

Define the investigations used to diagnose COPD

Answer 6

• No single diagnostic test: history and spirometry
• CXR to exclude other pathology

History;

• > 35 y.o.
• Presence of risk factors
• Presence of typical symptoms
• Absence of clinical features of asthma
• Airflow obstruction confirmed by post-bronchodilator spirometry

Question 7

Describe the differences between asthma and COPD

Answer 7

COPD;

• Smoking: nearly all
• Chronic productive cough
• SOB: persistent and progressive

Asthma;

• Common in >35
• SOB: variable
• Night-time SOB and/or wheeze
• Significant diurnal variation

Question 8

Define the investigations used to diagnose acute exacerbations of COPD

Answer 8

• CXR
• Blood gases
• FBC
• U&E
• Sputum culture

Question 9

Define the treatment of acute exacerbations of COPD

Answer 9

Primary care;

• Change in inhalers
• Oral steroids
• Antibiotics

Question 10

Define the treatment of acute exacerbations of COPD

Answer 10

Primary care;

• Change in inhalers
• Oral steroids
• Antibiotics

Secondary care;

• Oxygen
• Nebulised bronchodilator
• Oral/IV corticosteroids +/- antibiotics

Question 11

Describe the staging of COPD

Answer 11

1, mild: FEV1 80% or higher, diagnosed based on symptoms 
2, moderate: FEV1 50-79%
3, severe: FEV1 30-49%
4, very severe: FEV1 >30%
End stage

Question 12

Describe the investigations of COPD

Answer 12

Pulmonary function tests (in COPD);
- Lung volumes: increased RV, TLC, RV/TLC >30%
- Transfer factor: reduced gas transfer, TLco, Kco
Radiology;
- High res. CT

Question 13

Define type I respiratory failure

Answer 13

Decrease in PO2

Question 14

Define type II respiratory failure

Answer 14

Decrease in PO2 and increase in PCO2

Question 15

What are the signs of cor pulmonale?

Answer 15

• Tachycardia
• Oedema
• Congested liver
• ECHO: pulmonary hypertension, tricuspid regurgitation