COPD

Question 1

What are the 2 sub conditions under the term COPD?

Answer 1

Emphysema
Chronic bronchitis

Question 2

What type of lung disease is COPD?

Answer 2

Obstructive
<0.7

Question 3

What has to be present to receive a diagnosis of chronic bronchitis?

Answer 3

Chronic productive cough for at least 3 months over 2 consecutive years
Alternative explanations for the cough should always be excluded

Question 4

What pathological changes are seen in chronic bronchitis?

Answer 4

Goblet cell hyperplasia
Mucus hypersecretions
Chronic inflammation and fibrosis
Narrowing of small airways

Question 5

Pathological changes seen in patient:
- goblet cell hyperplasia
- mucus hypersecretions
- chronic inflammation and fibrosis
- narrowing of small airways
What is likely diagnosis?

Answer 5

Chronic bronchitis

Question 6

What is emphysema?

Answer 6

Abnormal airspace enlargement distal to the terminal bronchioles
Evidence of alveolar distraction
No obvious fibrosis
Destruction of the lung parenchyma leads to a reduced area for gas exchange and chronic hypoxia

Question 7

How are the alveolar destroyed in emphysema?

Answer 7

Proteases produced by neutrophils and macrophages
Proteases elastase destroys elastin

Question 8

What pathological changes are seen in emphysema?

Answer 8

Alveolar collapse
Alveolar dilation and Bullae formation (conjoining of neighbouring alveoli)

Question 9

What signs and symptoms are often seen in COPD?

Answer 9

Chronic SOB
Cough
Excess sputum
Wheeze
Recurrent Resp infections
Coarse crackles
Loss of cardiac dullness
Signs of CO2 retention (flapping tremor )

Question 10

What is used to assess the scale of breathlessness in someone with COPD? And what does each stage mean?

Answer 10

MRC dyspnoea scale
Grade 1 – Breathless on strenuous exercise
Grade 2 – Breathless on walking up hill/hurrying
Grade 3 – Breathless that slows walking on the flat
Grade 4 – Stop to catch their breath after walking 100 meters on the flat
Grade 5 – Unable to leave the house due to breathlessness

Question 11

What is diagnosis of COPD based on?

Answer 11

Clinical presentation + Spirometry

Question 12

How is severity of COPD graded? What is each value? (4)

Answer 12

Fev1 % of predicted

1 = mild, >80%
2 = moderate, 50-79
3 = severe, 30-49
4 = very severe, <30

Question 13

What cxr findings can be seen in COPD?

Answer 13

Hyperinflation

Question 14

What non-medical management is used in COPD? (4)

Answer 14

Stop smoking
Pneumococcal and annual flu vaccine
Pulmonary rehab
Manage comorbidities

Question 15

What is the stepwise treatment of COPD for someone who does not have asthmatic or steroid responsiveness? (3)

Answer 15

1. SABA/SAMA
2. LABA+ LAMA
3. 3 month trial of LABA + LAMA + ICS

Question 16

What is the stepwise treatment of someone with COPD who has asthmatic or steroid responsiveness? (3)

Answer 16

1. SABA/SAMA
2. LABA + ICS
3. LABA + LAMA + ICS

Question 17

What is the treatment for an acute COPD exacerbation at home? (3)

Answer 17

○ Prednisolone 30mg once daily for 7-14 days
○ Regular inhalers or home nebulisers
○ Antibiotics if there is evidence of infection

Question 18

What is the treatment for an acute COPD exacerbation in hospital? (4)

Answer 18

○ Nebulised bronchodilators (e.g. salbutamol 5mg/4h and ipratropium 500mcg/6h)
○ Steroids (e.g. 200mg hydrocortisone or 30-40mg oral prednisolone)
○ Antibiotics if evidence of infection
○ Physiotherapy can help clear sputum

Question 19

What is Doxapram? When is it used in COPD?

Answer 19

Used as a respiratory stimulant in COPD exacerbation if NIV or intubation is not appropriate

Question 20

What is the most common causative organism of an infective exacerbation of COPD?

Answer 20

Haemophilias influenzae