COPD

Question 1

What is the major risk factor for developing COPD

Answer 1

Cigarette smoking

Question 2

Describe the clinical features of COPD

Answer 2

• Cough (often productive)
• SOB
• Wheeze
• In severe cases, cor pulmonale

Question 3

What is the diagnostic investigation for COPD?

Answer 3

Lung function tests (spirometry) = diagnostic:

• FEV1/FVC ratio < 0.7 (obstructive pattern)
• FEV1 may be normal or reduced

Question 4

How can you objectively assess breathlessness?

Describe the components of this scoring tool

Answer 4

MRC (Medical Research Council) Dyspnoea Scale

• Grade 1 = breathless on strenuous exercise
• Grade 2 = breathless on walking up a hill
• Grade 3 = breathlessness that slows walking on the flat
• Grade 4 = stop to catch their breath after walking 100m on the flat
• Grade 5 = unable to leave the house due to breathlessness

Question 5

Describe the stepwise management of COPD (inhalers)

Answer 5

1) Start off with SABA e.g. salbutamol*
2) If they DON’T have asthmatic/steroid responsive features: add on combined LABA (e.g. salmeterol) + LAMA (tiotropium)
3) If they DO have asthmatic/steroid responsive features: add on combined LABA (e.g. salmeterol) + ICS (e.g. beclomethasone) [+LAMA* if necessary]

*Alternatively, can start off with a SAMA e.g. ipratropium

Question 6

In more severe cases of COPD, which additional treatments may be offered (in addition to inhalers)?

Answer 6

• Nebulised salbutamol and/or ipratropium
• Oral mucolytic therapy, e.g. carbocisteine
• Long term prophylactic antibiotics, e.g. azithromycin
• Long term oxygen therapy (LTOT)

Question 7

Which vaccinations should patients with COPD be offered? How often?

Answer 7

• Flu jab (annual)

- Pneumococcal jab (either one-off dose or every 5 years)

Question 8

What symptoms suggest an exacerbation of COPD?

Answer 8

Worsening of their usual symptoms:

• Increased cough/sputum production
• SOB

Question 9

In T1RF:

• Oxygen is…
• CO2 is…

Answer 9

In T1RF:

• Oxygen is LOW
• CO2 is NORMAL

Question 10

In T2RF:

• Oxygen is…
• CO2 is…

Answer 10

In T2RF:

• Oxygen is LOW
• CO2 is HIGH

Question 11

How can you tell if a patient with COPD is a retainer of CO2?

Answer 11

Look at the ABG:

• CO2 high
• pH normal (compensated by high bicarb)

Question 12

What oxygen saturations should you aim for in a patient with COPD who:

a) Retains CO2
b) Does NOT retain C02

Answer 12

a) 88-92%

b) above 94%

Question 13

How can an exacerbation of COPD be classified?

Answer 13

• Infective

- Non-infective

Question 14

How do you manage an exacerbation of COPD?

Answer 14

• Regular inhalers/nebs
• Oxygen if required
• Steroids (usually prednisolone 30mg for 7-14 days)
• Antibiotics (if infective exacerbation)

Question 15

Which intervention can be used in a severe exacerbation of COPD which is not responding to pharmacological management?

Answer 15

NIV (non-invasive ventilation)

Question 16

What are the typical CXR findings in a patient with COPD?

Why is it also important to perform a CXR in this cohort of patients?

Answer 16

• Hyperinflation
• Flat hemidiaphragm

Also important to exclude lung cancer in this cohort of patients