COPD

Question 1

What are some common precipitants of an exacerbation of COPD?

Answer 1

1. 60-80% infection: haemophilus influenza, morexella catarrhalis, strep oneumoniae, influenza, parainfluenza, coronaviruses, rhinoviruses
2. 20-40% non infectious: heart failure, PE, pneumotorax, non pulmonary infections, cold air, air pollution, allergens, smoking, non adherance to prescribed medications

Question 2

What is the treatment for an exacerbation of COPD?

Answer 2

• short acting bronchodilators
• anticholinergics eg ipratropium brominde
• prenisone 30-50mg daily for 7-14/7
• 5/7 doxycycline 100mg BD or amoxicillin 500mg TDS

Question 3

What are some causes of COPD?

Answer 3

Cigarette smoking (usually 20 pack years or more), air pollution, airway infection, occupation (cadmium, silica, dusts), genetic predisposition (including alpha1-anti trypsin deficiency), bronchial hyper responsiveness

Question 4

What is the COPDX guideline for diagnosis and management of COPD?

Answer 4

Confirm diagnosis
Optimise function
Prevent deterioration
Develop a self management plan
Manage exacerbations

Question 5

What are potential signs of COPD?

Answer 5

Tachypnoea, reduced chest expansion, hyper inflated lungs, hyper resonant percussion, dismissed breath sounds, wheeze, respiratory failure, signs of cor pulmonale
Pink puffers: always breathless
Blue bloaters: oedematous + central cyanosis

Question 6

What are the expected FEV1/FVC and FEV1 in COPD?

Answer 6

FEV1/FVC < 0.7

FEV1 < 0.8

Question 7

How do you confirm diagnosis in COPD?

Answer 7

Pulmonary function tests: post bronchodilator FEV1/FVC <0.8
Cxr: may be normal
Blood gases: may be normal, PaO2 down and PaCO2 up in advanced disease
ECG: may show Cor pulmonale
Sputum culture: to look for resistant organisms
FBC: to identify anaemia and polycythemia

Question 8

How do you optimise function in COPD?

Answer 8

S- smoking cessation
M- medication (inhaled bronchodilator, vaccines, steroid)
O- oxygen if needed (SpO2 <88%)
K- comorbidities (cardiac dysfunction, sleep apnoea, osteoporosis, depression, asyhma)
E- exercise and rehabilitation
S- surgery (bullectomy, lung volume reduction, lung transplant)

Question 9

How do you develop self management in COPD?

Answer 9

• develop support network: early referral to resp physician, consider psychology referral
• pulmonary rehabilitation
• GPMP with nurse, educator, physio, social worker, OT, dietician

Question 10

How do you mange exacerbations in COPD?

Answer 10

• diagnose based on at least 2 of: increasing dyspnoea at rest, reduced effort tolerance, tachypnoea, increased fatigue, incr asked cough and sputum, increased wheezing
• bronchodilators + spacer, systemic glucocorticoids, consider ventilatory support
• if cough, dyspnoea PLUS increased sputum and/or purulence then consider antibiotics