COPD

Question 1

How common is COPD?

Answer 1

-3rd leading cause of death
-Closely associated with smoking, deprivation and comorbidities

Question 2

What causes COPD?

Answer 2

-Progressive irreversible airway obstruction as a result of airway and parenchymal damage
-Reduced FEV1/FVC ratio <0.7
-Increased respiratory drive due to high PaCO2 / hypoxia
-Exposure to tobacco / pollution causes airway damage

Question 3

What risk factors are there for COPD?

Answer 3

-Gender (more common in women)
-Increasing age
-Recurrent URTIs in childhood
-Asthma
-Low SE status
-Alpha-1 antitrypsin deficiency

Question 4

How does COPD present?

Answer 4

-Exertional SOB
-Chronic cough
-Regular sputum production
-Frequent bronchitis / wheeze

Question 5

What signs might a COPD patient have on examination?

Answer 5

-Wheeze / crackles on auscultation
-Clubbing

Question 6

What are the differential diagnoses for COPD?

Answer 6

-Asthma
-Pulmonary fibrosis
-Bronchiectasis
-TB
-Malignancy
-Pneumonia

Question 7

How would you investigate a patient with COPD?

Answer 7

-FEV1/FVC ratio is the main diagnostic tool (<0.7)
-Detailed history including pack years
-Stage 1 = FEV1 >80% predicted
-Stage 4 = <30% predicted

Question 8

What treatment would you consider for COPD patients?

Answer 8

-MDT approach to include rehab, smoking cessation, vaccinations, spirometry
Combinations of the drugs below:
-SABA (salbutamol, terbutaline)
-LABA (formoterol, salmetrol)
-SAMA (ipratropium)
-LAMA (tiotropium, glycopyronium bromide)
-ICS (beclo, fluticasone)
–Triple therapy (LABA+LAMA+ICS)
-Abx and steroids for acute exacerbations