COPD

Question 1

What is COPD?

Answer 1

A non-reversible, long-term deterioration in airflow through the lungs caused by damage to lung tissue

Question 2

Diagnosis of COPD

Answer 2

Clinical presentation + spirometry

Question 3

What does spirometry show in COPD?

Answer 3

Obstructive picture

FEV1/FVC ratio <0.7

Does not show dramatic response to reversibility testing with beta-2 agonists

Question 4

How is severity of airflow obstruction graded?

Answer 4

Using the FEV1:

Stage 1: FEV1 >80% of predicted

Stage 2: FEV1 50-79% of predicted

Stage 3: FEV1 30-49% of predicted

Stage 4: FEV1 <30% of predicted

Question 5

Other investigations in COPD

Answer 5

CXR to exclude other pathology such as lung cancer

FBC for polycythaemia or anaemia

BMI as baseline to later assess weight loss (e.g. cancer or severe COPD) or weight gain (e.g. steroids)

Sputum culture to assess for chronic infection

ECG and echocardiogram to assess heart function

CT thorax for alternative diagnoses such as fibrosis, cancer or bronchiectasis

Serum alpha-1 antitrypsin to look for deficiency

Question 6

Long-term management of COPD

Answer 6

Smoking cessation

Pneumococcal and annual flu vaccine

SABAs

If not asthmatic, combined LABA + LAMA

If asthmatic, LABA + ICS

Question 7

When is LTOT used?

Answer 7

COPD that is causing problems such as chronic hypoxia, polycythaemia, cyanosis or heart failure secondary to pulmonary hypertension (cor pulmonale)

Cannot be used smoking as oxygen plus cigarettes is a significant fire hazard

Question 8

Presentation of acute exacerbation of COPD

Answer 8

Cough, shortness of breath, sputum production and wheeze

Usually triggered by viral or bacterial infection

Question 9

Target saturations in COPD

Answer 9

88-92% if CO2 retainer

Question 10

Medical treatment of an exacerbation of COPD

well enough to remain at home

Answer 10

Prednisolone 30mg once daily for 7-14 days

Regular inhalers or home nebulisers

Antibiotics if evidence of infection

Question 11

Medical treatment of an exacerbation of COPD

in hospital

Answer 11

Nebulised bronchodilators (e.g. salbutamol 5mg/4h and ipratropium 500mcg/6h)

Steroids (e.g. 200mg hydrocortisone or 30-40mg oral prednisolone)

Antibiotics if evidence of infection

Physiotherapy can help clear sputum

Question 12

Medical treatment of an exacerbation of COPD

severe cases not responding to treatment

Answer 12

IV aminophylline

Non-invasive ventilation (NIV)

Intubation and ventilation with admission to intensive care

Doxapram can be used as a respiratory stimulant where NIV or intubation is not appropriate