COPD

Question 0

What are triggers of Exacerbations?

Answer 0

Infectious
Bacterial: S pneumoniae, H influenzae, Moraxella catarrhalis
Viral: influenza, parainfluenza, rhinovirus, coronavirus

Non-infectious
Airborne pollutants, associated with other co-morbidities or non-specific

Question 1

What are causes of COPD?

Answer 1

Causes of COPD
• Smoking: 90% of COPD are smokers
• Alpha-1 antitrypsin deficiency
• Maternal smoking

Question 2

Clinical presentation?

Answer 2

Cough + sputum, often white in morning ± blood (streaks presumably)
SOB, often insidious and progressing to intrude on ADLs
Weight loss with advanced disease
Acute exacerbation is
• Worsened SOB
• Worsened cough
• Production of sputum

Question 3

Lab Ix?

Answer 3

CBE EUC LFT CRP BGL

ABG PFTs

Serum a-1 antitripsin

Question 4

Radiological Ix?

Answer 4

CXR
CT
ECG

Question 5

Diagnosing COPD?

Answer 5

Clinical + PFT obstructive pattern

Question 6

What is the difference between emphysema and chronic bronchitis?

Answer 6

• Chronic bronchitis: productive cough 3 months for 2 consecutive yrs
• Emphysema: dilation and destruction of air spaces distal to terminal bronchiole

Question 7

Goals for COPD management?

Answer 7

Two goals: optimise and prevent deterioration

Question 8

What are the features of polycythemia?

Answer 8

Headache
Tinnitus
Angina
Thrombosis venous 
Spleenomegaly

Question 9

How can you classify COPD?

Answer 9

Mild FEV1 of predicted value 60-80%
Moderate FEV1 40-60%
Severe <40%

Question 10

How would you treat mild COPD?

Answer 10

Non pharm - risk reduction
Optimise function - physical activity
Manage co-morbidities

Medications
- short acting reliever: SABA, ipratropium bromide

Question 11

How do you treat moderate disease?

Answer 11

Same as mild plus

• Refer to pulm rehab
• long acting anti muscarinic (tiotropium bromide) and/or LABA (salmeterol text)

If long acting started stop ipratropium bromide

Prevent Exacerbations
With inhaled glucocorticoids

Question 12

How do you treat severe?

Answer 12

Same as moderate plus

• consider 02 therapy
• surgery
• palliative
• advanced care directives

Question 13

What is the risk of achieving a O2 sat of greater than 92 in a pt who’s say 82?

Answer 13

Respiratory centre, centrally is driven by CO2. Peripherally it is driven by O2.

Therefore, 92 is sufficient enough to represent safe level of 02- Hb dissociation curve. But not so high to put CO2 retainers at risk.

CO2 - causes drowsiness and kills you slower than O2 deficiency