COPD

Question 1

what is chronic bronchitis?

Answer 1

increased mucus secretion in bronchial tree leading to a productive cough

Question 2

what is emphysema?

Answer 2

alveolar walls eaten away, decreased surface area for transfer and less supporting structures, collapse of small airways

Question 3

What are the symptoms of a patient with COPD?

Answer 3

Gradual increasing dyspnoea
Productive cough
wheeze
PND
chest pain
ankle swelling

Question 4

What will you find upon examination of a patient with COPD?

Answer 4

obese/cachexia
breathless walking
hyper resonant, poor air entry +/- wheeze
ankle oedema
raised JVP = cor pulmonale
tremor 
pursed lips
tripod posture (using accessory muscles to breathe)

Question 5

what are the indications for long term oxygen in COPD?

Answer 5

FEV1<30% predicted
clinically stable
stopped smoking
pO2< 7.3kPa (8 if cor pulmonale)

Question 6

What would you find during spirometers in someone with an obstructive disorder?

Answer 6

• FEV1 reduced
• FVC normal
• FEV1/FVC ratio reduced
• exhalation prolonged

Question 7

What would you find during spirometry in a patient with a restrictive disorder?

Answer 7

• FEV1 and FVC reduced
• FEV1/FVC ratio reduced
• exhalation prolonged

Question 8

Describe the drugs Tiotropium and Ipatropium Bromide and explain how they are used in COPD?

Answer 8

They are anticholinergic agents. They open up the medium and large airways in the lungs. Tiotropium is a capsule used in an inhaler.

Question 9

Why do you get breathless in COPD?

Answer 9

• hyperinflation/loss of elastic recoil. airflow is obstruction and there is loads of dead space, increased respiratory rate and decreased tidal volume.

Question 10

Describe the MRC dyspnoea scale?

Answer 10

0: no dyspnoea (apart from strenuous exercise)
1: dyspnoea when walking up an incline/hurrying
2: walks slower than most on the level, or stops after 15 minutes of walking on the level
3: stops after a few minutes of walking on the level
4: with minimal activity such as getting dressed, to dyspnoeic to leave the house.
a) independent washing/dressing
b) dependent washing/dressing

Question 11

What are the signs of respiratory failure?

Answer 11

reduced level of consciousness
central cyanosis
flapping tremor (asterixis)
oedema (cor pulmonale)

Question 12

what are the signs of respiratory failure?

Answer 12

• reduced level of consciousness
• central cyanosis
• flapping tremor (asterixis)
• oedema

Question 13

What chest signs can be found in someone with COPD?

Answer 13

• acute bronchitis/pneumonia/other
• poor air entry (bi-unilateral)
• wheeze
• crackles (coarse/fine)
• transmitted sounds

Question 14

What treatment should be given in acute exacerbation of COPD?

Answer 14

• prednisolone 30mg per day for 5 days
• nebulised bronchodilators
• antibiotics if 2/3 of increased dyspnoea, increased sputum purulence and increased sputum volume
• oxygen