COPD

Question 1

Key COPD symptoms

Answer 1

Main Symptoms:
SOB
Cough
Sputum Production

Others:
Chest Tightness
Wheezing
Airway Irritability

Advanced Disease:
Fatigue
Anorexia
Weight Loss

Question 2

Signs of COPD on Physical Examination

Answer 2

Often no or very minor signs on physical examination in mild-mod COPD

Tachypnoea
Reduced chest wall movement
Hyperinflated lungs
Hyper-resonant percussion
Diminished breath soudns +/- wheeze
Signs of respiratory failure - e.g. accessory muscle use
‘Pink Puffer’ - always SOB but better perfused, usually thinner
‘Blue bloater’ - less SOB, so centrally cyanosed, odematous
Signs of Cor Pulmonale (RV failure due to increased vascular resistance in lungs)

Question 3

Criteria for COPD diagnosis

Answer 3

Clinical diagnosis
Hx of increasing dyspnoea and sputum production in a lifetime smoker

*Unwise to make daignosis of chronic bronchitis / emphysema in patients who are not/were not smokers - unless family hx sugestive of alpha-antitrypsin deficiency

Question 4

Investigations in COPD

Answer 4

Spirometry (gold standard):
Post-bronchodilator FEV1/FVC of In chronic COPD, a reading of 88-90 may be acceptable

CXR: Not always routine, as can be normal even with advanced disease. Might show hyperinflation. Can be used to exclude lung cancer >1cm

Blood gases: May be normal. Increased PaCO2 and decreased PaO2 in advanced disease

ECG: May show evidence of cor pulmonale

FBC: To identify anemia or polycythemia

Sputum culture: if empirical Abx for purulent sputum fail

Question 5

What is the consultation checklist for COPD?

Answer 5

SMOKES

S - Smoking Cessation

M - Medication: Inhaled bronchodilator, vaccines (influenza, pneumococcus), corticosteroids (if indicated)

O - is Oxygen needed?

K - Komorbidities: cardiac dysfunction, sleep apnoea, psteoporosis, depression, asthma?

E - Exercise and rehabilitation –> encourage

S - Surgery: Bullectomy, lung volume reduction surgery, single-lung transplant?

Question 6

Outline plan for initial treatment in COPD

Answer 6

Mild - FEV1 60-80% predicted: Intermittend SABA prn

Mod - FEV1 40-50% predicted: Regular combined therapy - e.g. salbutamol + ipratropium (m3)

Severe - FEV1 <40% predicted: Add LABA +/- ICS

Question 7

When to refer?

Answer 7

If COPD patient unresponsive / sub-optimal improvement when taking SABA, M3 agent, LABA and ICS

Question 8

What defines a COPD exacerbation?

Answer 8

Acute onset over minutes-hours of at least two of:
Increasing SOB with use of accessory muslces
Reduced effort tolerance
Tachypnoea >25
Increased fatigue
Increased cough and sputum
Increased wheezing

Question 9

When to use oxygen in COPD patients?

Answer 9

Commenced if patient hypoxaemia ( assisted ventilation may be required if this occurs, so proceed carefully