COPD

Question 1

Presentation of COPD?

Answer 1

Smoker, chronic sob, cough, sputum production, wheeze, recurrent respiratory infections particularly in winter
Right sided heart failure- peripheral oedema

Question 2

Dyspnoea scale?

Answer 2

1- sob on strenuous exercise
2-sob when walking up hill
3-sob on walking flat
4-stop to catch breath at 100m
5- unable to leave house

Question 3

Diagnosis of COPD is based on?

Answer 3

Clinical presentation and spirometry

Question 4

Severity determined by FEV1?

Answer 4

1. > 80
2. 50-79
3. 30-49
4. Less than 30

Question 5

What is alpha 1 anti trypsin deficiency?

Answer 5

Lack of protease inhibitor produced by liver, which protects cells from neutrophil elastase.
COPD in young people, non smokers.

Question 6

A1AT gene found on?

Answer 6

Chromosome 14, autosomal recessive-co dominant
PiZZ genotype

Question 7

What do you see in A1AT?

Answer 7

Panacinar emphysema- lower lobes
Cirrhosis and hepatocellular carcinoma and cholestasis in children

Question 8

Management specific to A1AT?

Answer 8

Bronchodilators, IV alpha1 antitrypsin protein concentrates, lung volume reduction surgery, lung transplantation

Question 9

What else is decreased in COPD?

Answer 9

Transfer factor for carbon monoxide TLCO. Can be increased in asthma

Question 10

Management of COPD?

Answer 10

1. SABA or SAMA
2. If no asthmatic or steroid responsive features then LABA plus LAMA
3. If steroid responsive/ asthmatic- LABA plus ICS, if this doesn’t work then LABA/LAMA and ICS
   In severe cases nebulisers, oral theophylline, oral mucosa tic therapy carbocisteine, prophylactic Ab azithromycin and long term oxygen

Question 11

ABGs of COPD?

Answer 11

Respiratory acidosis, retaining CO2

Question 12

Medical treatment of exacerbation?

Answer 12

At home: prednisolone 30mg 7-14 days, inhalers/nebulisers, antibiotics
Hospital: nebuliser bronchodilators, steroids, antibiotics, physiotherapy
Severe cases: IV aminophylline, non invasive ventilation. Intubation and ventilation, doxapram (respiratory stimulant)

Question 13

COPD causes?

Answer 13

Smoking, A1AT, cadmium, coal, cotton, cement, grain

Question 14

CXR of COPD?

Answer 14

Hyperinflation, flat hemidiaphragm, Bullae (air space in lung)

Question 15

Who should be put on oxygen?

Answer 15

FEV1 less than 30, consider if between 30-49
Polycythaemia
Peripheral oedema
Cyanosis
Raised MVP
Oxygen sats less than 92

Question 16

Offer LTOT to:

Answer 16

Oxygen sats less than 7.3 or between 7.3 and 8 with polycythaemia, p oedema or pulmonary hypertension

Question 17

For smoking offer?

Answer 17

Nicotine replacement therapy, bupropion, varenicline

Question 18

Don’t coprescribe theophylline with?

Answer 18

Macrolide (azithromycin) or fluoroquinolone (levofloxacin)

Question 19

What can azithromycin do?

Answer 19

Prolong QT interval

Question 20

For peripheral oedema, cor pulmonary enzymes what should you use?

Answer 20

Loop diuretics

Question 21

In COPD which inflammatory markers are released?

Answer 21

Leukotriene B4, IL8 and TNF alpha

Question 22

Paraseptal emphysema affects?

Answer 22

Distal alveoli- periphery of lobules- can rupture and cause pneumothorax

Question 23

Pink puffers?

Answer 23

Pursed lip breathing to maintain pressure in airways

Question 24

On CXR air trapping can cause?

Answer 24

Hyperinflation, barrel chest so increased anterior to posterior diameter, increased radiolucency

Question 25

Why do you get pulmonary hypertension?

Answer 25

Vasoconstriction of arterioles in areas where tissue is damaged, so heart has to work harder and therefore enlarges causing cor pulmonale

Question 26

Most common organism causing infective exacerbations of COPD?

Answer 26

Haemophilus influenzae
Streptococcus pneumonia
Moraxella catarrhalis
Human rhinovirus- 30%

Question 27

In acute exacerbation of COPD what should you give patient?

Answer 27

Increase bronchodilator use/ consider via nebuliser
Prednisolone 30mg for 5 days
BNF- amoxicillin or clarithromycin or doxycycline

Question 28

Admit patient if?

Answer 28

Severe sob
Cyanosis
Acute confusion
Oxygen sats below 90
Social reasons
Significant comorbidities