COPD

Question 1

Comms: COPD

Answer 1

1) Two components to COPD - chronic bronchitis and empheysema - and most patients have a mixture of both
=Both components cause obstruction to air and so oxygen coming into the lungs

2) Chronic bronchitis
=Persisting damage to the airways due to inflammation, results in increased production of thick substance called mucous.
=Mucous traps bacteria but if not cleared can result in infection

3)Empheysema
=Damage to the alveoli - sac-like structures at the end of lung branches
=Poor exchange of oxygen to the blood and carbon dioxide for the blood

Question 2

What are the main causes of COPD?

Answer 2

• SMOKING

- Alpha-1 antitrypsin deficiency

Question 3

What are the symptoms of COPD?

HINT: x5

Answer 3

Symptoms

• SOB
• Cough
• Sputum production
• Wheeze
• NO diurnal variation and less reversibility than asthma

Question 4

What are the investigations of COPD?

Answer 4

Culture
-Sputum = +ve for infective exacerbation

Bloods
-ABG = Respiratory failure/respiratory acidosis

Imaging
-CXR

Other
-Spirometry (GOLD)

Question 5

What are the clinical signs of COPD?

HINT: x8

Answer 5

• Clubbing
• Peripheral cyanosis (severe)
• Hypoxia
• Distended neck veins
• Tachypnoea
• Barrel chest
• Hepato-splenomegaly
• Hepato-Jugular reflux

Question 6

What are the CXR signs of a COPD patient?

[Hint: x4]

Answer 6

• Hyperinflation
• Flattened diaphragm
• Increased intercostal spaces
• Decreased lung markings
• Bullae

MUST EXCLUDE LUNG MASS

Question 7

What would spirometry show in a COPD patient?

Answer 7

NB: For all obstructive lung disease

FEV1 = reduced +++
FVC = reduced + OR normal
FEV1/FVC = reduced >70% normal

In COPD no evidence of reversibility

Question 8

What is the general/conservative management for COPD?

Answer 8

• STOP SMOKING
• Annual influenza vaccination
• One-off pneumococcal vaccination
• Oxygen therapy if required

Question 9

What is stage 1/first line treatment for COPD?

Answer 9

Bronchodilator

-SABA (salbutamol) or SAMA (ipatropium)

Question 10

If symptoms persist despite stage 1 what determines stage 2 treatment?

Answer 10

IF FEV1 > 50%
-LABA (salmetrol) OR LAMA (tiotropium)

IF FEV1 < 50%
-LABA + inhaled corticosteroid OR LAMA

Question 11

If at stage 2 treatment and symptos persist what is stage 3 treatment?

Answer 11

IF ON LABA ONLY
-Switch to LABA + ICS

IF ON LAMA ONLY
-Add LABA + ICS

Question 12

What other medical treatment maybe given to COPD patients?

Answer 12

Mucolytics
-If chronic productive cough

Oral theophylline
-If unable to take inhaled therapy

Question 13

Which bacteria are more commonly involved in infective exacerbations of COPD?

Answer 13

Haemophilus influenzae (most common cause)
Streptococcus pneumoniae
Moraxella catarrhalis

Viruses cause up to 30% - most commonly human rhinovirus

Question 14

What is the management strategy for infective COPD exacerbations?

Answer 14

• Increase frequency of bronchodilator use
• Consider nebuliser BUT only run through AIR
• Prednisolone 30mg for 7-14 days
• Oral antibiotics - IF purulent sputum or signs of pneumonia