COPD

Question 1

Define COPD

Answer 1

irreversible obstruction of the airways. It comprises both chronic bronchitis, which involves hypertrophy and hyperplasia of the mucus glands in the bronchi, and emphysema, which involves enlargement of air spaces and destruction of alveolar walls.

Question 2

How does smoking cause emphysema

Answer 2

Increase in neutrophil elastase, reduction in alpha-1 antitrypsin activity –> loss of elastic recoil and airway collapse

Question 3

Stages of COPD

Answer 3

Stage 1 Mild FEV1 ≥ 80% predicted

Stage 2 Moderate FEV1 50-79% of predicted

Stage 3 Severe FEV1 30-49% of predicted

Stage 4 Very Severe FEV1 <30% of predicted

Question 4

Bloods for COPD

Answer 4

Raised PCV = polycythaemia

Question 5

COPD CXR

Answer 5

Hyperinflated chest (>6 anterior ribs)

Bullae

Decreased peripheral vascular markings

Flattened hemidiaphragms

Question 6

Management of COPD: non-pharma

Answer 6

Stop smoking
Nutritional support
Flu vaccinations
Pulmonary rehabilitation

Question 7

Management of COPD: pharmacological

Answer 7

Step 1: SABA or SAMA

Step 2 (persistent exacerbations)
- no asthmatic features OR responsiveness to steroids –> add a long acting B2 agonist (LABA) AND a long acting muscarinic antagonist (LAMA). (discontinue SAMA)
- asthmatic features or evidence of steroid responsiveness –> add LABA + ICS

Step 3: LAMA + LABA + ICS trial for 3 months

Question 8

What are features of asthma

Answer 8

asthma/atopy history, raised eosinophils, reduced FEV1 or diurnal variations in peak flow

Question 9

Indications for LTOT

Answer 9

• If non-smokers: PaO2 <7.3kPa on two readings more than 3 weeks apart
• PaO2 of 7.3-8kPa alongside one of other features: nocturnal hypoxia, polycythaemia, peripheral oedema and pulmonary hypertension.

Question 10

Indications for COPD surgery

Answer 10

Lung-volume reduction surgery:
- They have upper lobe predominant emphysema
- FEV1 >20% predicted
- PaCO2 below 7.3 kPa
- TlCO above 20% predicted.