COPD

Question 1

Causes of COPD?

Answer 1

Smoking
Alpha-1 antitrypsin deficiency

Question 2

Features of COPD?

Answer 2

Cough: often productive
dyspnoea
wheeze
severe- R sided heart failure resulting in peripheral oedema

Question 3

COPD investigations?

Answer 3

FEV1/FVC ratio less than 70%
Chest x-ray
full blood count- exclude secondary polycythaemia
body mass index calculation

Question 4

Chest x-ray findings in COPD?

Answer 4

Hyperinflation
Bullae
Flat hemidiaphragm

Question 5

How long should patients on long-term oxygen therapy breathe supplementary oxygen for?

Answer 5

At least 15 hours a day

Question 6

Patients should be assessed for long term oxygen therapy if they have?: (6)

Answer 6

FEV1 less than 30%
Cyanosis
Polycythaemia
Peripheral oedema
Raised jugular venous pressure
O2 sats less than 92% on air

Question 7

What is Polycythemia?

Answer 7

High conc of RBC in blood- type of blood cancer

Question 7

How is long term oxygen therapy assessment done?

Answer 7

By measuring arterial blood gases on 2 occasions at least 3 weeks apart
PO2 <7.3 kPa

Question 8

First line treatment for COPD?

Answer 8

A short acting beta2-agonist (SABA) or short acting muscarinic antagonist (SAMA)

Prednisolone 30mg daily for 5 days

Question 9

When is oral theophylline recommended in COPD?

Answer 9

After shot/long acting bronchodilators and people who cannot use inhaled therapy

Question 10

Most common infective causes of COPD exacerbations?

Answer 10

Bacteria:
Haemophiliac influenza
Strep pneumonia
Moraxella catarrhalis

Resp viruses:- 30% of exacerbations
Human Rhinovirus

Question 11

Symptoms of clubbing, haemoptysis or chest pain should investigated a they may be a cause of? (3)

Answer 11

Lung cancer
Pulmonary fibrosis
Heart failure

Question 12

What is cor pulmonale?

Answer 12

R sided heart failure caused by resp disease
Increased pressure and resistance in the pulmonary arteries limits the r ventricle pumping blood into the pulmonary arteries.

This causes back pressure into the R atrium, vena cava and systemic venous system

Question 13

Causes of cor pulmonale are?

Answer 13

COPD (most common cause)
Pulmonary embolism
Interstitial lung disease
Cystic fibrosis
Primary pulmonary hypertension

Question 14

Arterial blood gas findings in acute exacerbation of COPD?

Answer 14

Low pH= acidosis
Low pO2- hypoxia and resp failure
Raised pCO2 indicates CO2 retention (hypercapnia)
Raised bicarbonate indicates chronic retention of CO2

Question 15

Target O2 sats for patient with COPD?

Answer 15

94-98%

Question 16

Target o2 sats for patient at risk of hypercapnia?

Answer 16

88-92%

Question 17

Treatment of acute exacerbation of COPD with no signs of infection e.g. sputum or fever?

Answer 17

Increase use of bronchodilator inhaler and 5 day course of oral prednisolone