COPD

Question 1

What is COPD?

Answer 1

Persistent respiratory symptoms and airflow limitation (breathlessness, cough, sputum).

Common, preventable, and treatable.
Not fully reversible.

Airway and/or alveolar abnormalities - usually caused by noxious particles.

Question 2

What is the prevalence and incidence of COPD?

Answer 2

2nd most common lung disease behind asthma.
Prevalence is increasing.
Incidence is decreasing.

Males, older, poorer standard of living.

Question 3

What is the aetiology of COPD?

Answer 3

Smoking and pollution.
Impaired lung growth.
Lung injury and inflammation.
Small airway disorders.
Asthma / emphysema / bronchitis.
Childhood infection.
Occupational.

Question 4

How can alpha-1 antitrypsin deficiency cause COPD?

Answer 4

A rare, inherited disease in early-onset COPD.
Low AAT leads to alveolar damage.
Associated with liver fibrosis and cirrhosis.

Question 5

How can smoking cause COPD?

Answer 5

Increases respiratory symptoms and lung function abnormalities.
Increases annual rate of FEV1 decline and COPD mortality rate.

Environmental smoke may be a factor.
Smoking in pregnancy may affect lung growth and immune system priming.

Question 6

What are symptoms of COPD?

Answer 6

Cough, SOB, sputum, frequent chest infections, wheezing.

Weight loss, fatigue, swollen ankles.

Question 7

What are examination findings of COPD?

Answer 7

Cyanosis.
Raised JVP.
Cachexia.
Pursed lip breathing.
Hyperinflated chest.
Use of accessory muscles.
Peripheral oedema.

Question 8

How can you diagnose COPD?

Answer 8

Typical symptoms present.
>35 years.
Are present to risk factors.
Have no clinical features of asthma.
Have airflow obstruction confirmed by post-bronchodilator spirometry.

Question 9

How can spirometry diagnose COPD?

Answer 9

FEV1/FVC < 0.7 post-bronchodilator (a lack of reversibility).

Mild - FEV1 > 80%.
Moderate - 50% < FEV1 < 79%.
Severe - 30 < FEV1 < 49%.
Very severe - FEV1 < 30%.
Stages may not match with clinical wellness.

Question 10

What history questions do you ask to diagnose COPD?

Answer 10

Cough - worse at night, how much sputum, variation, steroid response, triggers.
SOB - intermittent, gradually worsens.

PMH - childhood chest problems, asthma, recurrent bronchitis, TB, pneumonia.

FH - allergies, eczema, hayfever.

SH - smoking (packs, years), occupation.

Question 11

What pulmonary function tests can be done to diagnose COPD?

Answer 11

Lung volumes (increased RV and TLC).
RV/TLC > 30% (emphysema).

CO gas transfer (decreased Tco and Kco).

Question 12

How can a CXR diagnose COPD?

Answer 12

Excludes alternate pathology.
Screens for malignancy.

Look for - vascular hila (due to pulmonary hypertension), hyperinflation, bulla, a small heart, and a flat diaphragm.

Question 13

How can you classify people with COPD?

Answer 13

Based on history.
Obesity can artificially raise FEV1/FVC.

Question 14

What are the suggestive features of COPD, to separate it from differential diagnoses?

Answer 14

Slowly progressive symptoms.
Onset in midlife.
A history of tobacco smoking.
Night-time waking or diurnal symptoms are uncommon.

Question 15

How can an HRCT diagnose COPD?

Answer 15

Signet ring signs.
Honeycombing.
Traction bronchiectasis.
Lung cysts.
Centrilobular emphysema.

Question 16

What are acute exacerbations of COPD in primary care?

Answer 16

Worsening symptoms.
Unable to smoke.
Systemic upset.
Temperature if infective.
Fatigue.

Question 17

What are the signs of severe exacerbation of COPD?

Answer 17

RR > 25.
Accessory muscle use at rest.
Pursed lip breathing.
SaO2 < 92%.
Significant decrease in exercise tolerance.
Signs of sepsis if infective.
Fluid retention.
Confusion.

Question 18

What are differential diagnoses of COPD?

Answer 18

Pneumonia.
Lung cancer.
Pleural effusion.
Pneumothorax.

Question 19

What are acute exacerbations of COPD in secondary care?

Answer 19

Triggers (infection, drugs, trauma).
Cyanosis.
Severe breathlessness.
Flapping tremors.

Question 20

What tests can be done for acute exacerbations of COPD in secondary care?

Answer 20

CXR.
Blood gases.
FBC.
U&E.
Sputum cultures.
Ventricular tachycardia.

Question 21

How can you treat acute exacerbations of COPD in secondary care?

Answer 21

Oxygen.
Nebulised bronchodilator.
Oral/IV corticosteroids.

Question 22

How can you measure the severity of COPD?

Answer 22

Spirometry.
Symptoms.
History of moderate and severe exacerbations and future risk.
Co-morbidities.

Question 23

How can COPD cause respiratory failure?

Answer 23

Reduced ventilation (small airways).
Reduced perfusion (fewer alveoli).
Reduction is matched.

Type I - decreased PO2.
Type II - decreased PO2, increased PCO2.
(Ventilatory failure, very severe).

Question 24

What can hypercapnia cause in COPD?

Answer 24

Drowsiness, flapping tremors, twitching.
Acidic blood increases the risk of death.

Question 25

Why is a SaO2 of 88-92% aimed for in COPD?

Answer 25

Ventilatory problems lead to reduced CO2 sensitivity of chemoreceptors in the medulla.
A ‘hypoxic drive’ is developed.

Question 26

How can COPD cause cor pulmonale?

Answer 26

Right-sided heart failure due to lung disease.
Smoking and hypoxia cause vasoconstriction and shunts blood flow to healthy alveoli.
Tachycardia, oedema, raised JVP.

Secondary polycythaemia occurs (increased erythropoietin production in response to low O2 levels). Hb, haematocrit % and blood viscosity increase (higher risk of strokes).

Question 27

What is end stage COPD?

Answer 27

A terminal illness.
Unpredictable and acute decline.
Palliation of symptoms is important, especially in the breathless and anxious.

Consider social aspects - care, housebound, O2.

Question 28

What is the burden of COPD?

Answer 28

The 2nd largest cause of emergency admissions.
Expensive treatment.

Question 29

What are public health measures to decrease COPD risk?

Answer 29

Anti-smoking legislations.
Age of purchase, picture warnings, ban on smoking in cars carrying children.

Question 30

Why should you treat other co-existing conditions in COPD?

Answer 30

People with COPD often have other co-morbidities.