COPD

Question 1

what is the definition of COPD?

Answer 1

chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible

Question 2

what is parenchyma and what does it lead to?

Answer 2

obstruction such as a tumour which leads to the loss of alveolar attachment and decreases the lung elastic recoil
this reduces the ability of the airways to remain open

Question 3

what are some clinical features of COPD?

Answer 3

cyanosis, cost wall deformities, hyper inflated lungs, peripheral oedema and pursed lip breathing

Question 4

what is the aetiology of COPD?

Answer 4

smoking, air pollution, occupation, age also more prevalent in developing countries and females

Question 5

how does alpha-1-antitripsyn deficiency relate to COPD?

Answer 5

presents in young people with COPD, cause alveolar damage and basal emphysema

Question 6

what are some other long conditions that could lead to COPD?

Answer 6

asthma, chronic bronchitis and recurrent chest infections

Question 7

what are symptoms of COPD?

Answer 7

cough, dyspnoea, sputum, chest infections, swollen ankles

Question 8

how would you diagnose COPD?

Answer 8

by looking at symptoms, taking history and spirometry, chest x-rays for hyperinflation or flat diaphragm, vascular vila or small heart

Question 9

what are some key questions you should ask while diagnosing ?

Answer 9

are your symptoms worse at night?
how much sputum are you producing?
is there variation in your symptoms?
are there any triggers?
is there a response to steroids?
have you had any childhood chest problems?
any family history with allergies/asthma /hay fever or eczema?

Question 10

what are acute exacerbations seen in primary care?

Answer 10

yellow/green sputum
unable to smoke
not able to drink/eat
temperature and fatigue

Question 11

what are some severe exacerbations that could be seen I primary care?

Answer 11

respiratory rate less than 25
no exercise tolerance
signs of sepsis
confusion
cyanosis
O2 sats less than 92%
purse lip breathing

Question 12

how could someones COPD be triggered and they end up in secondary care?

Answer 12

viral/bacterial infection
sedative drugs
pneumothorax
trauma

Question 13

what tests need to be done if a patient with COPD end up in secondary care?

Answer 13

chest x-ray
blood gas
full blood count
kidney function
sputum culture
viral throat swab

Question 14

whats type 1 and type 2 respiratory failure?

Answer 14

type 1- hypoxia, decrease in pO2

type 2- hypercapnia, ventilatory failure, decrease in pO2 and increase in pCO2

Question 15

what conditions could be caused by severe COPD?

Answer 15

cor pulmonale

secondary polycythaemia

Question 16

what is secondary polycythaemia?

Answer 16

high erythropoietin
high haemoglobin
high blood viscosity

Question 17

is COPD a cause for finger clubbing?

Answer 17

no

Question 18

whats the 1st, 2nd and 3rd wave of things to treat in a patient with COPD?

Answer 18

1st- improve exercise tolerance, prevent exacerbations
2nd- nutriton and complications (cor pulmunale, respiratory failure etc.)
3rd- mental health, co-morbidities, dysfunctional breathing and palliative care

Question 19

what are non pharmacological ways to manage COPD?

Answer 19

stop smoking
vaccination
pulmonary rehabilitation
nutritional and psychological support

Question 20

what are 2 pharmacological ways to manage COPD?

Answer 20

1. inhaled therapy- short acting bronchodilators (SABA, SAMA)
   - long acting bronchodilators (LAMA, LABA)
   - high dose corticosteroids + LABA
2. long term O2 therapy (must not have smoked for 6 months, must be hypoxic PaO2 less than 7.3kPa)