COPD

Question 1

Signs and symptoms of COPD

Answer 1

CO retention flap
Tripod stance
Reduced pO2
Bounding pulse - co2 retention
Bruising from steroid use
Crackles

Question 2

What heart condition do you need to look for in COPD

Answer 2

Cor pulmonale - where pulmonary hypertension results in right sided heart failure

Question 3

Signs of cor pulmonale

Answer 3

Raised JVP
Hepatomegaly
Parasternal heave
Loud pulmonary second heart sound

Question 4

What is FEV1 vs FVC

Answer 4

FEV1 - exhalation in 1 second
FVC - how much you can exhale totally after inhalation

Question 5

Normal FEV1 and normal FVC

Answer 5

Over 80 percent

Question 6

Normal FEV1 to FVC ratio

Answer 6

Over 70 percent

Question 7

How can you compare obstructive vs restrictive lung diseases?

Answer 7

The FEV1 to FVC ratio would be normal in restrictive disease, as both are reduced individually.

In obstructive, the ratio would be reduced because FVC is normal/only slightly reduced.

Question 8

Asthma vs COPD FEV1 to FVC

Answer 8

Asthma - reversible
COPD - not reversible, ratio under 70 percent

Question 9

How do you classify COPD

Answer 9

Mild - FEV1 over 80
Moderate - FEV1 - 50-80
Severe - 30-50
Very severe - under 30

Question 10

In COPD, what x ray changes do you see and why?

Answer 10

Hyperexpansion - look for whether the diaphragm looks flat, and if the diaphragm is being intersected by ribs 5-7 of the anterior (curved) ribs.

The lower border of the heart may be seen as floating

Bullae - black spaces

Question 11

Management of COPD

Answer 11

1. SABA or SAMA
2. LABA and LAMA or LABA and ICS
3. LABA, LAMA, ICS

Question 12

What is SAMA

Answer 12

short acting muscarinic antagonist - e.g. ipratropium bromide

Question 13

Give an example of a LABA ICS combo

Answer 13

Symbicort - formoterol plus budesonide

Question 14

Give examples of non-inhaled therapies

Answer 14

Mucolytic such as carbocysteine
Theophylline

Question 15

Give examples of non pharmacological management of COPD

Answer 15

Smoking cessation
Pulmonary rehab
Pneumococcal/influenza vaccines
Lung transplant

Question 16

Give examples of oxygen therapy in end stage COPD

Answer 16

Long term oxygen therapy = LTOT
Ambulatory home oxygen therapy - if only hypoxemic on extertion

Question 17

When would you prescribe LTOT

Answer 17

If the pO2 was below 7.3 kPa (55mmHg, normal range is 75-100mmHg)
or below 8 with pulmonary HTN, pulmonary oedema or secondary polycythemia

Question 18

When would you prescribe ambulatory home oxygen therapy?

Answer 18

If hypoxemic on exertion only

Question 19

How much oxygen can be delivered via a nasal cannula

Answer 19

up to 2 L

Question 20

What is the oxygen delivery system between a nasal cannula and a venturi face mask and how much can it deliver?

Answer 20

Hudson normal face mask - 6 L

Question 21

What are the venturi mask colours

Answer 21

Bullies - Blue - 2-4 L
Want - White - 4-6L
Your - Yellow - 8-10 L (not 6)
Ripe - Red - 10-12 L
Grapes - 12 - 15 L

Question 22

How do you manage acute COPD exacerbation

Answer 22

Oxygen
Nebulised salbutamol 2.5mg/4 hours
Steroids - 30mg prednisolone or 200mg hydrocortisone
Antibiotics
Chest physio
BiPAP if hypercapnic acidosis and not responding to mx in 1 hr
IV aminophylline
ITU

Question 23

When do you consider ITU in someone with COPD

Answer 23

If pH is below 7.26