COPD

Question 1

what is the definition of COPD?

Answer 1

• Fixed airflow obstruction
• Minimal/no reversibility with bronchodilators
• Minimal variability in day-to-day symptoms
• Slowly progressive deterioration in lung function

mostly due to smoking

Question 2

what is the pathology of COPD?

Answer 2

Mucous gland hyperplasia in the large airways with associated mucous hypersecretion
-> chronic cough.

• Squamous metaplasia -> replacement of normal ciliated columnar epithelium with squamous epithelium.
• Loss of cilial function results in impaired clearance from the lung

Chronic inflammation and fibrosis of small airways with inflammatory cell infiltration

Emphysema due to alveolar wall destruction and irreversible enlargement of airways distal to the terminal bronchiole, with subsequent loss of elastic recoil and hyperinflated lungs.

Question 3

what are 4 clinical features of COPD?

Answer 3

• Dyspnoea
• Decreased exercise tolerance
• Productive cough
• Wheeze

Question 4

what are 4 investigations used to diagnose COPD?

Answer 4

• Spirometry (FEV1/FVC <0.7)
• Minimal bronchodilator reversibility

-↑ total lung volume & residual volume

• Consider checking α1-antitrypsin levels

Question 5

what are 4 non-pharmacological management techniques?

Answer 5

• Ensure correct diagnosis
• Smoking cessation
• Pulmonary rehabilitation
• Diet
• Psychosocial support

Question 6

what are pharmacological management techniques?

Answer 6

• bronchodilators SABA/LABA
• Inhaled steroids

-Theophylline

-Oxygen therapy

• Vaccination (influenza and pneumococcal)
• Antibiotics

Question 7

what are 6 management techniques for infective exacerbation?

Answer 7

• Antibiotics
• Inhaled/nebulised bronchodilators
• Controlled O2 therapy (24-35% via venturi facemask)
• IV aminophylline

-NIV

• ITU referral?