COPD

Question 1

Define chronic bronchitis

Answer 1

Cough and sputum production on

most days for 3mo of 2 successive years.

Question 2

Define emphysema

Answer 2

histological diagnosis of enlarged air
spaces distal to terminal bronchioles with destruction of
alveolar walls.

Question 3

What is the spirometry pattern in COPD?

Answer 3

Airway obstruction: FEV1 <80%, FEV1:FVC <0.70

Question 4

Four signs of COPD?

Answer 4

  Tachypnoea 
  Prolonged expiratory phase 
  Hyperinflation 
  Wheeze 
  May have early-inspiratory crackles 
  Cyanosis 
  Cor pulmonale: ↑JVP, oedema, loud P2 
  Signs of steroid use

Question 5

Two signs of hyperinflation?

Answer 5

displaced liver edge
loss of cardiac dullness
reduced cricosternal distance

Question 6

What is the name of the dyspnoea scale that assesses impact of breathing in COPD?

Answer 6

MRC dyspnoea score/scale

Question 7

Patient with COPD stops for breath <100m/few min. What is their MRC score?

Answer 7

4

1. Dyspnoea only on vigorous exertion
2. SOB on hurrying or walking up stairs
3. Walks slowly or has to stop for breath
4. Stops for breath after <100m / few min
5. Too breathless to leave house or SOB on dressing

Question 8

Three complications of COPD?

Answer 8

  Acute exacerbations ± infection 
  Polycythaemia 
  Pneumothorax (ruptured bullae) 
  Cor Pulmonale 
  Lung carcinoma

Question 9

Aside from spirometry, name three other investigations for COPD

Answer 9

CXR- rule out other pathology + see hyperinflation
FBC
Echo
BMI
ECG
CT thorax
Sputum culture
Serum alpha1 antitrypsin

Question 10

Which deficiency predisposes you to COPD?

Answer 10

alpha 1 antitrypsin

Question 11

Which abnormality in FBC result might you see in COPD patient?

Answer 11

polycythaemia= raised Hb due to response to chronic hypoxia

Question 12

Severity staging in COPD is based on which parameter?

Answer 12

FEV1

Question 13

FEV1 60%. What is the severity stage of COPD?

Answer 13

Mod/stage 2

 Mild/stage 1: FEV1 >80% (but FEV/FVC <0.7 and symptomatic)
 Mod: FEV1 50-79%
 Severe: FEV1 30-49%
 Very Severe: FEV1 < 30%

Question 14

Aside from pharmacological management, name three approaches to managing COPD

Answer 14

1. Stop smoking
2. Pulmonary rehab
3. Influenza and pneumococcal vaccine
4. Nutrition and reduce weight

Question 15

COPD is only breathless upon exercise, which drug do you give them?

Answer 15

SABA and/or SAMA PRN

Question 16

COPD patient has persistent breathlessness, what drug do you give them?

Answer 16

LABA + LAMA + ICS

Question 17

Aside from inhalers, name one other pharmacological agent that can be prescribed for COPD?

Answer 17

mucolytic with productive cough= carbocisteine

Question 18

Management of acute exacerbation of COPD?

Answer 18

similar protocol to acute asthma

Sit patient upright
24% venturi mask
Salbutamol and ipratropium nebuliser
IV steroids- hydrocortisone
Abx if infection

Question 19

Two modes of NIV?

Answer 19

BiPAP or CPAP

Question 20

One contraindication to NIV?

Answer 20

pneumothorax or other structural abnormality, facial deformation

Question 21

Two pressures applied in BiPAP?

Answer 21

IPAP- inspiratory, air forced into lungs

EPAP- expiratory, provides pressure during expiration so airways doen’t collapse

Question 22

How should COPD exacerbation be monitored?

Answer 22

ABG after every hour if any treatment changes made.

ABG after every 4 hours until stable

Question 23

Two indications for CPAP?

Answer 23

Obstructive sleep apnoea
Congestive cardiac failure
Acute pulmonary oedema

Question 24

What are clinical features present in both COPD and HF progression?

Answer 24

wheeze, cough, SOB at rest, chest tightness, SOB on exertion, chronic symptoms

Question 25

How to distinguish between COPD and heart failure?

Answer 25

HF- ankle swelling, positional, wake up gasping.

COPD- increased sputum production

Question 26

Which cells are involved in COPD inflammation?

Answer 26

macrophages, CD8 and CD4 T lymphocytes, neutrophils

Question 27

Describe the mechanism of airflow obstruction in emphysema/COPD

Answer 27

loss of elasticity and alveolar attachments due to emphysema, results in airways collapse on expiration, causes airtrapping and hyperinflation. Goblet metaplasia with mucus plugging of lumen, inflammation of the airway wall, thickening of bronchiolar wall- smooth muscle hypertrophy and peribronchial fibrosis

Question 28

Does haemoptysis feature in COPD?

Answer 28

rarely

Question 29

Name two features of COPD that would suggest steroid responsiveness

Answer 29

• previous diagnosis of asthma or atopy
• a higher blood eosinophil count
• substantial variation in FEV1 over time (at least 400 ml)
• substantial diurnal variation in peak expiratory flow (at least 20%)