COPD

Question 1

What are the causes of exacerbations of COPD?

Answer 1

Infective (doesn’t include pneumonia)

HF

PE

Question 2

What are some physical signs of COPD?

Answer 2

Hyperresonance to purcussion

Barrel chest

Dull breath sounds

Question 3

Define COPD

Answer 3

A progressive condition of irreversible airflow limitation due to an ongoing, abnormal inflammatory response to noxious stimuli

Question 4

Describe the epidemiology of COPD

Answer 4

3rd leading cause of disease burden in Aus

500,000 Australians have moderate COPD

Question 5

Describe 4 microscopic aspects of the COPD pathophysiology

Answer 5

Destruction of alveolar septa

Loss of elasticity

Inflammatory cell infiltrate - Neutrophils, macrophages, CD8+

Destruction of pulmonary capillary bed

Question 6

How do you make the diagnosis of COPD?

Answer 6

Spirometry

(RFT)

Question 7

By what factor is FER reduced for COPD to be diagnosed?

Answer 7

70%

(FER = FEV1 / FVC)

Question 8

Why might FVC be low in COPD lungs?

Answer 8

Gas trapping

Question 9

What is chronic bronchitis?

Answer 9

Inhalation of a noxious stimulus that causes production of mucus chronically

Question 10

In which airways does inflammation generally occur? What is the consequence?

Answer 10

Peripheral

Fibrosis and obliterative bronchiolitis

Question 11

What are some long acting beta2 agonists used in COPD?

Answer 11

Salmeterol

Eformaterol

Indacaterol (ultra long acting)

Question 12

Name some anticholinergics used in COPD?

Answer 12

Tiotropium (spiriva)

Ipratropium (atrovent)

Question 13

What is the mechanism of action of tiotropium (spiriva)

Answer 13

It’s an anticholinergic - Blocks M3 muscarinic receptors on smooth muscle cells and submucosal glands to reduce bronchocontriction and mucus secretion

Question 14

What are some side effects of anticholinergics?

Answer 14

Dry mouth

Question 15

When are inhaled corticosteroids indicated in COPD?

Answer 15

GOLD Criteria Stage III and IV

(III - FEV1 = 30-50% predicted)

Incombination with LABA

Question 16

What is seratide a combination of?

Answer 16

Salmeterol and fluticasone

Question 17

What is pulmonary rehabilitation?

Answer 17

Patients develop mastery of their airways

Question 18

What is the benefit of oxygen home therapy?

Answer 18

Improves mortality

Reduces pulmonary hypertension

Question 19

Why does lung reduction surgery help in COPD?

Answer 19

Bad lung impinges on good lung

Question 20

What therapies can be used in exacerbations?

Answer 20

O2

Antibiotics

Bronchodilators

Corticosteroids

Physical activity

Non-invasive ventilation

Question 21

How do you approach the Ix and Mx of IECOPD?

Answer 21

Ix

• FBE, UEC
• CXR
• Blood culture
• ABG

Management

• O2, aim sats 88-92% (if CO2 retainer)
• Bronchodilators - Salbutamol, up to 12 puffs prn, Ipatropium up to 5 buffs
• Steroids - Pred ~50mg, 3d
• Antibiotics - oral doxycycline/amoxicillin

Question 22

Clinically, what defines an exacerbation of COPD?

Answer 22

Change in cough

Change in character of sputum

Increase in dyspnoea

Question 23

What is the casade of treatment for COPD

Answer 23

Gold 1 (FEV1 >80%) Short acting beta-agonist

Gold 2 (50-80%) SABA and LAMA

Gold 3 (30-50%) SABA, LAMA, consider inhaled corticoid steroid/LABA

Gold 4 (<30) Consider Oral steroids, Home O2, and Surgical reduction of the lung

Question 24

How is chronic bronchitis diagnosed?

Answer 24

Chronic cough for most days of the weeks for 3 months of the a year

Question 25

What does COPDX stand for?

Answer 25

Confirm diagnosis

Optimise lung function

Prevent decline

Develop support network

X - prevent exacerbations