COPD

Question 1

triad of COPD

Answer 1

emphysema
chronic bronchitis
small airway fibrosis

Question 2

chronic bronchitis

Answer 2

productive cough for at least 3 months in 2 consecutive years

Question 3

risk factors

Answer 3

tobacco smoking
indoor air pollution (developing world)
alpha-1-antitrypsin deficiency

Question 4

alpha-1-antitrypsin deficiency

Answer 4

autosomal dominant condition
presents in younger patients (20-40)

leads to destruction of alveolar structures -> early-onset emphysema

some cases involve impaired secretion of alpha-1-antitrypsin by liver -> accumulation in liver, and therefore cirrhosis

Question 5

alpha-1 antitrypsin

Answer 5

protease inhibitor

prevents neutrophil elastase from breaking down alveolar structures

Question 6

MRC dyspnoea scale

Answer 6

1 - SOB during strenuous exercise only
2 - SOB when hurrying/walking up slight incline
3 - slower walk than people of same age/needs to pause for breath when walking at own pace
4 - pause for breath after walking 100m/few mins on level
5 - too breathless to leave house, or sob when dressing

Question 7

COPD Assessment Test (CAT)

Answer 7

impact of patient’s COPD on wellbeing and daily life

score ranges from 0-40 - higher score, greater impact on daily life

Question 8

signs

Answer 8

most common
tachypnoea
wheeze on auscultation
pursed lips breathing

less common
barrel chest
peripheral cyanosis
cor pulmonale 
CO2 retention flap

Question 9

differential diagnoses

Answer 9

asthma
bronchiectasis
congestive cardiac failure
lung cancer
tuberculosis

Question 10

bedside investigations

Answer 10

spirometry
pulse oximetry
sputum culture
ECG

Question 11

lab investigations

Answer 11

baseline blood tests = FBC, U&E, LFTs, CRP
arterial blood gas (ABG)
- during stable disease : PaCO2 >6.0 and bicarbonate >30 indicates CO2 retention
during exacerbations : check for resp acidosis (PaCO2 >6.0 and pH >7.35)

Question 12

imaging

Answer 12

CXR : hyperinflation
>6 anterior ribs or >10 posterior ribs visible in midclavicular line
flattened diaphragm
hyperlucent lungs

Question 13

conservative management

Answer 13

smoking cessation
pulmonary rehab
annual flu vax , one off pneumococcal vax
personalised self management plan

Question 14

medical management

Answer 14

inhalers - step up process as needed
SABA -> LABA and LAMA (no asthamatic) LABA and ICS (asthmatic) -> LABA and LAMA and ICS (no asthmatic) LABA and LAMA and ICS (asthmatic)
long term O2 therapy
indications - SpO2 <88%
PaO2<7.3kPa
contraindications - current smokers due to risk of explosion and/or burns

Question 15

surgical management

Answer 15

lung volume-reduction surgery - very severe COPD, not responding to optimal medical management
lung transplantation

Question 16

complications

Answer 16

hypercapnic resp failure 
secondary polycythaemia
cor pulmonale 
bronchiectasis
anxiety & depression
osteoporosis
sleep disturbance

Question 17

hypercapnic resp failure

Answer 17

elevated level of CO2 in blood and near normal or not enough O2 in blood

Question 18

cor pulmonale

Answer 18

sign of right heart failure , such as peripheral oedema and hepatomegaly

due to pulmonary hypertension, resulting from pulmonary vasoconstriction
RV undergoes hypertrophy and dilatation

Question 19

severity grading of COPD

Answer 19

mild - >80%
moderate - 50-80%
severe - 30-50%
very severe - <30%