COPD

Question 1

What is COPD?

Answer 1

*airflow obstruction caused by inflammation of airways
*mucus- bronchioles lose shape and become clogged with mucus.
*air trapping- fewer alveoli
*structural changes due to repeated injury and repair
*progressive- not fully reversible, but treatable
*parenchymal damage

Question 2

What usually causes COPD?

Answer 2

Smoking

Question 3

What is airflow obstruction?

Answer 3

FEV1/FVC <0.7

Question 4

What is emphysema?

Answer 4

Loss of parenchymal lung structure

Question 5

What is the pathogenesis of smoking and COPD?

Answer 5

Smoking inflames the lungs
Causes oxidative stress on lungs

Question 6

What physiological abnormalities are associated with COPD?

Answer 6

*mucus hypersecretion- chronic productive cough
*ciliary dysfunction- difficulty removing mucus
*airflow obstruction and hyperinflation- breathlessness and limited exercise capacity
*gas exchange abnormalities- hypo anemia and hypercapnia
*pulmonary hypertension

Question 7

When is COPD suspected?

Answer 7

*aged 35+
*with a risk factor
*>1 symptom
-breathlessness
-chronic cough
-regular sputum production
-frequency lower resp tract infections
-wheeze
* cyanosis, hyperinflated lungs on examination

Question 8

What is the MRC breathlessness (dyspnoea) scale?

Answer 8

Grade 1- not troubled
Grade 2- short of breath when hurrying or walking slight hill
Grade 3- walk slow cuz of breathlessness, has to stop for breath
Grade 4- stop for breath walking 100m
Grade 5- too breathless to leave house, breathless from dressing

Question 9

What is a normal FEV1 and FVC?

Answer 9

FVC- 4L
FEV1- Above 3 L

Question 10

What is the classification of severity for airflow limitation? (GOLD)

Answer 10

*GOLD 1- mild - FEV1>80% predicted
*GOLD 2- moderate- FEV1 between 50-80% predicted
*GOLD 3- severe- FEV1 between 30-50% predicted
*GOLD 4- VERY SEVERE- FEV1 <30% predicted

Question 11

What are the goals of COPD therapy?

Answer 11

*relieve symptoms
*prevent disease progression
*improve exercise tolerance and health
*prevent and treat exacerbations and complications
*reduce mortality

Question 12

How do you clean spacers?

Answer 12

Water and washing up liquid- allow to air dry

Question 13

When should a nebuliser be considered?

Answer 13

Distressing or disabling breathlessness

Question 14

What additional oral treatments are available?

Answer 14

*corticosteroids- prednisone- monitor for osteoporosis
*methylxanthines- theophylline- dose related toxicity
* mucolytics- carbocisteine- not used for exacerbations
*FUROSEMIDE- for peripheral oedema in cor pulmonale

Question 15

How often should a COPD patient be reviewed?

Answer 15

Mild/moderate = annually
Very severe= twice a year

Question 16

What is the definition of an exacerbation of COPD?

Answer 16

*rapid and sustained worsening of symptoms that is beyond usual day to day symptoms
*worsening breathlessness
*cough
*wheeze
*increased sputum

Question 17

What are FIVE factors to consider when assessing the need to treat patients at hospital or home?

Answer 17

*able to cope at home yes or no
*breathlessness mild or severe
*general condition good or deteriorating
*rapid rate of onset yes or no
*significant co morbidity eg diabetes yes or no