COPD

Question 1

what is COPD defined as and FEV

Answer 1

progressive disease characterised by airway obstruction with little or no reversibililty. FEV <0.7

Question 2

what does COPD involve

Answer 2

chronic bronchitis and emphysema

Question 3

what are some risk factors for COPD

Answer 3

age >35 yrs, smoking, chronic dyspnoea, sputum, day to day variation in FEV1

Question 4

what is chronic bronchitis defined as

Answer 4

clinically- cough and sputum production for 3 months of 2 years. symptoms improve if stop smoking

Question 5

what is emphysema defined as

Answer 5

histologically- enlarged air spaces distal to terminal bronchioles, destruction alveolar walls

Question 6

what is the prevalence of COPD

Answer 6

10-20% of over 40s

Question 7

what are pink puffers

Answer 7

increased alveolar ventilation, normal PaO2 and normal or low PaCO2.

Question 8

are pink puffers breathless or cyanosed

Answer 8

breathless

Question 9

what can pink puffers lead to

Answer 9

type 1 respiratory failure

Question 10

what are blue bloaters

Answer 10

decreased alveolar ventilation, low PaO2 and high CO2

Question 11

are blue bloaters breathless or cyanosed

Answer 11

not breathless, but are cyanosed

Question 12

what can blue bloaters develop

Answer 12

cor pulmonale

Question 13

symptoms of COPD

Answer 13

cough, sputum, dyspnoea, wheeze

Question 14

signs of COPD

Answer 14

tachypnoea, use of accessory muscles, hyperinflation, decr cricosternal distance, decr expansion, resonant or hyperresonant, wheeze, cyanosis, cor pulmonale, quiet breath sounds

Question 15

complications of COPD

Answer 15

acute exacerbations +- infection, polycythaemia (incr RBCs), respiratory failure, cor pulmonale (oedema, incr JVP), pneumothorax, carcinoma

Question 16

what does the CXR show

Answer 16

hyperinflation, flat hemidiaphragms, large central pulmonary arteries, decr peripheral vascular markings, bullae (dilated air space in the lung parenchyma)

Question 17

what can the ECG show in COPD

Answer 17

RVH and LVH in cor pulmonale

Question 18

lung function results in COPD

Answer 18

obstructive + air trapping-> FEV < 80% of predicted and FEV1/FVC ratio <0.7. TLC incr, RV incr, DLCO decr in emphysema.

Question 19

treatment COPD

Answer 19

smoking cessation, diet advice and supplements, mucolytics can help chronic productive cough, LTOT

Question 20

when can LTOT be given to patients

Answer 20

clinically stable non smokers PaO2 <7.3kPa; if PaO2 7.3-8 and pulmonary hypertension, or polycythaemia, or peripheral oedema, or nocturnal hypoxia; terminally ill patients

Question 21

what is the classification of COPD patients

Answer 21

stage 1 mild (FEV1<30%)

Question 22

drugs used in mild

Answer 22

antimuscarinic or SABA eg ipratropium

Question 23

drugs used in moderate

Answer 23

inhaled long acting antimuscarinic or LABA eg tiotropium

Question 24

drugs used in severe

Answer 24

combination LABA + corticosteroids eg Symbicort- budesonide + formoterol or tiotropium

Question 25

drugs used in pulmonary hypertension

Answer 25

LTOT. diuretics

Question 26

when might NIV be appropriate

Answer 26

hypercapnic on LTOT

Question 27

indications for surgery

Answer 27

recurrent pneumothoraces, isolated bullous disease, lung vol reduction surgery

Question 28

what is steroid responsive

Answer 28

give 30mg prednisolone for 2 weeks. if FEV1 rises by >15% then steroid responsive

Question 29

acute exacerbation of COPD is an emergency. when can it happen

Answer 29

in winter, triggered by bacterial/ viral infection

Question 30

presentation of acute exac

Answer 30

incr cough, breathlessness, or wheeze. decr exercise capacity

Question 31

differential diagnosis acute exac

Answer 31

asthma, pulmonary edema, pulmonary embolus, URT obstruction, anaphylaxis

Question 32

investigations in acute exac

Answer 32

ABG, CXR (exclude pneumothorax and infection), FBC, U&E, CRP, ECG, sputum for culture, blood cultures if pyrexial

Question 33

complications from invasive ventilation

Answer 33

ventilator associated pneumonias, pneumothoraces from ruptured bullae

Question 34

management of acute exac

Answer 34

nebulized bronchodilators (salbutamol, ipratropium); controlled o2 therapy if sats <7 (start 24-28%); steroids (hydrocortisone + prednisolone); antibiotics if infection (amoxicillin); physio- sputum; if no response- aminophylline

Question 35

if there is no response to drugs in acute exac

Answer 35

NIPPV (non invasive positive pressure ventilation). intubation and ventilation. respiratory stimulant drug eg doxapram