COPD

Question 1

COPD

Answer 1

chronic obstructive pulmonary disease
= common, progressive disease, characterised by airway obstruction that is mostly irreversible. Includes chronic bronchitis and emphysema
usually COPD if > 35 years with Hx smoking, sputum production and no diurnal FEV variation

Question 2

Diagnosis/Presentation

Answer 2

Dyspnoea - progressive, worse on exercise, persistent
Chronic cough - productive
Decreased exercise tolerance
FHx

Question 3

Ix

Answer 3

Spirometry - FEV1/FVC <0.7 and decreased FEV1/predicted

CXR - hyperinflation
ECG - RVH from cor pulmonale
ABG - Pa02 decreased with or without hypercapnia
FBC - exclude secondary polycythemia (inc RBC)

Question 4

Examination

Answer 4

General: 
pursed lips breathing, use of accessory muscles 
prolonged forced expiration 
sputum 
cachexia 
tachypnea 

Hands:
cyanosis, polycythemia
CO2 retention flap

Face neck:
cyanosis, tracheal tug, reduced criosternal distance

Chest : 
Intercostal recession, barrell chested 
Reduced chest wall movement 
Hyper-resonant percussion 
Reduced breath sounds 
\+/- wheeze, early corse insp crackes

Question 5

Assessment of COPD

Answer 5

Symptoms 
Spirometry 
Risk of exacerbations - ICU admissions?
Treatment used - steroids? inhalers? 
Co-morbidities - CVD?

Question 6

COPD DD?

Answer 6

Asthma - onset earlier, varied symptoms day2day,
CHF - fluid overload, CXR findings, restrictive pattern
Bronchiectasis - more sputum, CXR findings
TB -

Question 7

Non-pharm treatment

Answer 7

smoking cessation
smoke exposure 
pulmonary rehab - exercise lol 
Influenza vaccine, pneumococcal vaccine
O2 therapy
Ventilation therapy - Non-Invasive positive pressure vent (NIPPV) = improves survival not QOL 
Weight loss

Question 8

Pharm management - chronic

Answer 8

Chronic:

1. LAMA (+/- SABA
2. LABA
3. ICS
4. Diuretics of Cor Pulmonale)

Question 9

Acute Ix + management

Answer 9

ABG: 
    PaO2 < 8 = resp failure 
    PaCO2 < 6.7 = type I 
    PaCO2 > 6.7 = type II (happens when global ventilation 
    affected)
CXR

ECG

Bloods
FBC - polycythemia or bleeding
UEC

Treatment:
Oxygen, SABA
systemic corticosteroids
Abx - doxy or amox 
MDT + Lifestyle