COPD

Question 1

Define COPD.

Answer 1

COPD is a chronic, slowly progressive disorder characterised by AIRFLOW OBSTRUCTION that does not change markedly over several months. Most of the lung function IMPAIRMENT IS FIXED, although there can be some reversibility using bronchodilators –> A FIXED AIRFLOW OBSTRUCTION.

Question 2

What causes the symptoms of COPD?

Answer 2

Small airway narrowing, inflammation and mucous - chronic bronchitis and emphysema. Thickening of the airway wall, loss of elasticity and disrupted alveolar attachments.

Question 3

What is the prevalence of COPD?

Answer 3

900000 diagnosed cases, 50% undiagnosed. Male predominance. 6th most common cause of death in UK, 5th worldwide.

Question 4

What are the impacts on QOL for a patient with COPD?

Answer 4

Severe - 30% of patients have trouble sleeping and 85% cannot climb the stairs.

Question 5

Describe the main causes of COPD.

Answer 5

85% - SMOKING. 15% - other causes, including: chronic asthma, passive smoking, maternal smoking, air pollution, occupation and alpha-1-antitrypsin deficiency.

Question 6

What are the genotypes of alpha-1-antitrypsin?

Answer 6

PiMM is normal. PiZZ is abnormal - causes COPD in younger people.

Question 7

Describe the links between COPD and smoking.

Answer 7

Only 20% of smokers develop clinically significant COPD - other factors. Usually have > 20 pack year smoking history, reduction in collagen in lungs and skin and

Question 8

What is the typical presentation of a COPD patient?

Answer 8

Over 40, smoker/ex-smoker, breathless on exertion and cough. Must have no features of variable airflow (asthma) - COPD is fixed airflow obstruction.

Question 9

What are the differential diagnoses for COPD?

Answer 9

Asthma, LC, LVF, fibrosing alveolitis, bronchiectasis, TB or recurrent pulmonary emboli.

Question 10

Which clinical signs may be seen on a COPD patient?

Answer 10

Tachypneoa (breathing quickly) breathlessness, pursed lip breathing, using accessory muscles of breathing, cyanosis, CO2 flapping tremor, barrel chest, decreased breath sounds, cor pulmonale (raised JVP, oedema etc). History of chest infections and winter bronchitis.

Question 11

What are the essential investigations for COPD?

Answer 11

1) Demonstrate obstruction of airflow by spirometry: FEV1

Question 12

What are the useful investigations for COPD?

Answer 12

CXR, ABG, full blood count (anaemia, polycythaemia (> haemoglobin), eosinophils), ECG and sputum culture (looking for S.pneumoniae, HiB or M.catarrhalis).

Question 13

What can cause an acute exacerbation of COPD?

Answer 13

Viral/bacterial infection or air pollution, both of which inflame the airways.

Question 14

What are the symptoms of acute exacerbations of COPD?

Answer 14

> Cough, sputum, purulent sputum, SOB, wheeze, oedema, not able to sleep, confusion, drowsiness etc.

Question 15

Describe some non-respiratory symptoms of COPD.

Answer 15

Loss of muscle mass, weight loss, cardiac disease, depression and anxiety.

Question 16

COPD or asthma?

Answer 16

COPD: > 35, persistent and productive cough, smoker, progressive and persistent breathlessness, no nocturnal symptoms, no FH.

Asthma: any age, intermittent and non-productive cough, possible smoker, intermittent and variable breathlessness, commonly nocturnal symptoms, FH and allergic rhinitis/eczema.

Question 17

How can severity of COPD be defined by spirometry?

Answer 17

> 80% mild, 50-79% moderate, 30-49% severe,

Question 18

What are the aims and interventions for COPD?

Answer 18

1) Prevention of disease progression - stop smoking. 2) Relieve breathlessness - inhalers. 3) Prevention of exacerbations - inhalers, vaccination, pulmonary rehabilitation. 4) Management of complications - long term O2 therapy.

Question 19

Describe non-pharmaceutical ways of managing COPD.

Answer 19

Stop smoking, vaccination (flu and pneumococcal), pulmonary rehabilitation, nutritional assessment and psychological support.

Question 20

What does pulmonary rehabilitation entail?

Answer 20

Baseline outcome assessment, optimisation of pharmocotherapy, exercise prescription, patient education, psychological support, nutritional support, diagnosis of co-morbidities, self-management and maintenance strategies.

Question 21

What are the benefits of pharmacological management?

Answer 21

Relieve symptoms, prevent exacerbations and improve QOL.

Question 22

Describe different inhaled therapies for COPD.

Answer 22

Short acting bronchodilators: salbutamol, ipratropium

Long acting bronchodilators: anti-muscarinics (tiotropium) B2 agonist (salmeretrol)

High dose ICS and LABA: relvar and symbicort.

LABA should be given to all patients. ICS should be added if FEV1

Question 23

When would long term O2 therapy (LTOT) be given?

Answer 23

PaO2

Question 24

How should an acute exacerbation of COPD (AECOPD) be managed?

Answer 24

Short-acting bronchodilators (salbutamol/ipratropium), steroids (prednisolone), antibiotics (only if evidence of infection). Consider hospital admission: tachypneoa, low O2 saturation (