COPD

Question 1

2 components of COPD and their diagnosis/definition

Answer 1

Chronic bronchitis (clinical diagnosis):

• Presence of chronic productive cough lasting 3 months for 2 consecutive years

Emphysema (pathological diagnosis):

• Abnormal, permanent enlargement of air spaces distal to terminal bronchioles
• Accompanied by destruction of walls WITHOUT obvious fibrosis

Question 2

Risk factors for COPD

Answer 2

(SADFAP):

• Smoking
• Age
• Decreased BMI
• Female
• Alpha-1 antitrypsin deficiency - panacinar emphysema
• PHx of TB

Question 3

Symptoms of COPD

Answer 3

• Productive cough - colourless, sputum
• Dyspnoea
• Wheezing

Question 4

Signs of COPD

Answer 4

• General inspection:
  
  • Cachexia
  • Use of accessory muscles
  • Pursed lips
  • Tripod sitting position
• Chest:
  
  • Barrel chest
  • Hyperresonant percussion
  • Wheezing
  • Decreased breath sounds
  • Prolonged expiration

Question 5

Spirometry diagnosis of COPD

Answer 5

FEV₁/FVC <70%

Question 6

Signs of COPD on CXR

Answer 6

• Hyperinflation
  
  • More visible ribs
  • Increased intercostal spaces
  • Flattened diaphragm
  • Bullae (hyperlucent air pockets)

Question 7

Triggers of exacerbation of COPD

Answer 7

• Infection:
  
  • Bacterial - CAP organisms:
    
    • Strep. pneumoniae
    • H. influenzae
    • M. catarrhalis
  • ​Viral:
    
    • Rhinovirus
    • Influenza
    • RSV
• Airborne pollutants - smoke, SO₂, NO_2, O₃
• GORD
• Idiopathic

Question 8

Management of exacerbation of COPD

Answer 8

• Short-acting bronchodilators
  
  • Salbutamol/ipratropium
• Systemic glucocorticoids
  
  • Prednisolone
• Home oxygen therapy - if smoking ceased for ≥1 year
• Non-invasive positive pressure ventilation (NIPPV)
• Antibiotics
  
  • Amoxicillin/doxycycline

Question 9

Investigations of COPD

Answer 9

• Spirometry
• PEFR
• Sputum culture
• FBE
  
  • HCT - increased (chronic hypoxia)
  • WBC - infective exacerbation
  • RBC - polycythaemia (compensatory)
• ABG
• CXR
• High-resolution CT

Question 10

Management of COPD

Answer 10

• Short-acting bronchodilators
  
  • SABA - salbutamol, terbutaline
  • SAMA - ipratropium
• Long-acting bronchodilators
  
  • LABA - salmeterol, eformoterol
  • LAMA - tiotropium
• Inhaled corticosteroids
  
  • Budesonide
  • Fluticasone propinoate/furoate
• Combined LABA/ICS
  
  • Seretide - fluticasone propionate + salmeterol
  • Symbicort - budesonide + eformoterol
• Theophylline

Question 11

Symptoms of exacerbation of COPD

Answer 11

• Change in:
  
  • Dyspnoea
  • Cough
  • Wheeze
  • Sputum
    
    • Volume
    • Colour
    • Thickness