COPD

Question 1

What is chronic obstructive pulmonary disease (COPD)?

Answer 1

COPD is a progressive respiratory condition characterised by airflow limitation due to chronic bronchitis and/or emphysema.

Question 2

What are the main pathological features of COPD?

Answer 2

Pathological features include chronic inflammation, mucus hypersecretion, airway narrowing, and destruction of alveoli (emphysema).

Question 3

What are the common symptoms of COPD?

Answer 3

Symptoms include chronic cough, sputum production, dyspnoea, and wheezing.

Question 4

What are the signs of COPD on clinical examination?

Answer 4

Signs include tachypnoea, prolonged expiration, wheezing, hyperinflated chest, and use of accessory muscles for breathing.

Question 5

What are the risk factors for developing COPD?

Answer 5

Risk factors include smoking, long-term exposure to air pollution, occupational dust and chemicals, and alpha-1 antitrypsin deficiency.

Question 6

What is the most common cause of COPD?

Answer 6

The most common cause is cigarette smoking.

Question 7

What is the pathophysiology of COPD?

Answer 7

Chronic inflammation leads to airway remodelling, mucus hypersecretion, and destruction of alveolar walls, resulting in airflow limitation and impaired gas exchange.

Question 8

How is COPD diagnosed?

Answer 8

Diagnosis is confirmed with spirometry showing a post-bronchodilator FEV1/FVC ratio <70%.

Question 9

What are the spirometry findings in COPD?

Answer 9

Spirometry shows an obstructive pattern with a reduced FEV1/FVC ratio and a reduced FEV1.

Question 10

What is the role of a chest X-ray in COPD?

Answer 10

Chest X-ray may show hyperinflation, flattened diaphragms, and increased retrosternal airspace, though it is not diagnostic.

Question 11

What is the role of blood tests in COPD diagnosis?

Answer 11

Blood tests, such as alpha-1 antitrypsin levels, can identify genetic causes of COPD, while arterial blood gases assess hypoxaemia and hypercapnia.

Question 12

What is the GOLD classification in COPD?

Answer 12

GOLD (Global Initiative for Chronic Obstructive Lung Disease) classifies COPD severity based on FEV1 (% predicted) and symptom burden.

Question 13

What are the differential diagnoses for COPD?

Answer 13

Differential diagnoses include asthma, bronchiectasis, pulmonary fibrosis, and heart failure.

Question 14

What is the initial management of stable COPD?

Answer 14

Management includes smoking cessation, bronchodilators, inhaled corticosteroids, pulmonary rehabilitation, and vaccination.

Question 15

What bronchodilators are used in COPD?

Answer 15

Short-acting bronchodilators (e.g., salbutamol) and long-acting bronchodilators (e.g., tiotropium, salmeterol) are used to relieve symptoms.

Question 16

What is the role of inhaled corticosteroids in COPD?

Answer 16

Inhaled corticosteroids reduce inflammation and exacerbations, particularly in patients with frequent exacerbations or asthmatic features.

Question 17

What vaccinations are recommended for COPD patients?

Answer 17

Annual influenza vaccination and pneumococcal vaccination are recommended to prevent respiratory infections.

Question 18

What lifestyle modifications are recommended for COPD patients?

Answer 18

Smoking cessation, regular physical activity, and maintaining a healthy diet are crucial.

Question 19

What are the complications of COPD?

Answer 19

Complications include respiratory failure, pulmonary hypertension, cor pulmonale, and recurrent respiratory infections.

Question 20

What is the management of an acute exacerbation of COPD?

Answer 20

Management includes nebulised bronchodilators, corticosteroids, antibiotics (if indicated), and oxygen therapy (target SpO2 88-92%).

Question 21

What are the triggers for COPD exacerbations?

Answer 21

Triggers include respiratory infections, air pollution, and inadequate medication adherence.

Question 22

What is the role of long-term oxygen therapy (LTOT) in COPD?

Answer 22

LTOT is used in patients with chronic hypoxaemia to improve survival and reduce complications such as pulmonary hypertension.

Question 23

What is pulmonary rehabilitation?

Answer 23

Pulmonary rehabilitation is a programme of exercise, education, and support to improve quality of life and physical fitness in COPD patients.

Question 24

What is the prognosis for COPD?

Answer 24

Prognosis depends on disease severity, with advanced COPD associated with significant morbidity and mortality.

Question 25

What are the indications for referral to secondary care in COPD?

Answer 25

Indications include severe or rapidly progressing disease, frequent exacerbations, need for long-term oxygen therapy, or suspicion of alternative diagnoses.