COPD

Question 1

What is the prevalence of COPD in the UK?

Answer 1

1.2 million
2% of population

Question 2

What causes COPD?

Answer 2

Smoking and pollutants
Alpha 1 antitrypsin deficiency
Certain occupantions
Female predisposes to COPD

Question 3

What are the symptoms of COPD?

Answer 3

Cough, breathlessness, sputum, frequent chest infections, wheezing

Less common,
Weight loss, fatigue, swollen ankles

Question 4

What are COPD examination findings?

Answer 4

Cyanosis, raised JVP, cachexia, wheeze, peripheral oedema, use of accessory muscles, hyper inflated chest, pursed lip breathing

Question 5

What are the grades of the mMRC breathlessness scale?

Answer 5

0 - normal
1 - SOB when hurrying on level ground or walking up hill
2 - Slower than most because of breathlessness
3 - SOB after walking 100 yards or after a few minutes
4 - Too breathless to leave house or breathlessness when dressing

Question 6

How is COPD diagnosed?

Answer 6

-Based on symptoms, history and spirometry.

-Diagnoses COPD if meets the following criteria:
-typical symptoms
->35 years
-presence of risk factor (smoking or occupational exposure)
- absence of clinical features of asthma

AND
- airflow obstruction confirmed by post bronchodilator spirometry

Question 7

What are the stages of COPD based on spirometry?

Answer 7

Stage 1, mild - FEV1 80% or higher of normal (diagnosis is based on respiratory symptoms only)
Stage 2, moderate - FEV1 50-79% of predicted
Stage 3, severe - FEV1 of 30-49%
Stage 4, v severe - FEV1 less than 30%

Question 8

What would an acute exacerbation in primary care look like?

Answer 8

Worsening of normal symptoms:

Unable to smoke; upset to eating, drinking; temperature; fatigue

In addition to above severe exacerbation would look like:

RR > 25
Accessory muscle use at rest
Confusion, sepsis, decrease in exercise tolerance

Question 9

How do you manage an acute exacerbation in primary care?

Answer 9

Antibiotics, oral steroids, change in inhalers

Question 10

What can occur in severe disease?

Answer 10

Respiratory failure
Cor pulmonale
Secondary polycythaemia

Question 11

What is COPD?

Answer 11

Emphysema and chronic bronchitis

Question 12

How is COPD treated?

Answer 12

Smoking cessation
Pulmonary rehabilitation
Treat co-morbidities
Vaccinations against flu etc
Inhalers (bronchodilators and steroids)
Long term oxygen if PaO2 less than 7.3 kPa or 7.3-8 if peripheral oedema, nocturnal hypoxia, polycythaemia, pulmonary hypertension