COPD

Question 1

What is COPD?

Answer 1

COPD is a common progressive disorder characterised by airway obstruction (FEV1 <80% predicted; FEV1/FVC <0.7) with little or no reversibility.

Question 2

Do patients with COPD usually suffer from asthma?

Answer 2

NO

Question 3

What is COPD favoured by?

Answer 3

• Age of onset >35 years
• Smoking (passive or active) or pollution related
• Chronic dyspnoea
• Sputum production
• Minimal diurnal or day-to-day FEV1 variation

Question 4

What is chronic bronchitis?

Answer 4

defined clinically as cough, sputum production on most days for 3 months of 2 successive years

Question 5

How can the symptoms of chronic bronchitis be improved?

Answer 5

stop smoking

Question 6

What is emphysema?

Answer 6

Emphysema is defined as histologically as enlarged air spaces distal to terminal bronchioles, with destruction of alveolar walls but often visualised on CT

Question 7

What are the features of a pink puffer?

Answer 7

• increased alveolar ventilation
• Near normal PaO2
• Normal or low PaCO2
• Breathless but not cyanosed
• May progress to type I respiratory failure

Question 8

What are the signs of a blue bloater?

Answer 8

• decreased alveolar ventilation
• Low PaO2
• High PaCO2
• Cyanosed but not breathless
• May develop cor pulmonale
• Respiratory centres are insensitive to CO2 and they rely on hypoxic drive to maintain respiratory effort

Question 9

What are the main symptoms of COPD?

Answer 9

• Cough
• Sputum
• Dyspnoea
• Wheeze

Question 10

What are the main signs of COPD?

Answer 10

• Tachypnoea
• Use of accessory muscles
• Hyperinflation
• decreased cricosternal distance (<3cm)
• decreased expansion
• Resonant or hyper-resonant percussion note
• Quiet breath sounds
• Cyanosis
• Cor pulmonale

Question 11

What complications can occur in COPD?

Answer 11

• Acute exacerbations ± infection
• Polycythaemia
• Respiratory failure
• Cor pulmonale (oedema, #JVP)
• Pneumothorax (ruptured bullae)
• Lung carcinoma

Question 12

What tests should be performed in COPD?

Answer 12

• FBC: Increased PCV
• CXR: hyperinflation, vascular markings, bullae
• CT: Bronchial wall thickening, scarring, air space enlargement
• ECG: right atrial and ventricular hypertrophy (cor pulmonale)
• ABG: decreased PaO2 ± hypercapnia
• Spirometry: obstructive + air trapping (FEV1:FVC ratio <70%, increased TLC, increased RV, decreased DLCO in emphysema)

Question 13

What are the main drugs used for the treatment of COPD

Answer 13

SABA - salbutamol
SAMA - ipatropium
LABA - salmetrol
LAMA - tiotopium
ICS - beclomethosone
Mucolytics - carbocestine