COPD

Question 1

What are the common examination findings?

Answer 1

Inspection - O2, inhalers, SOB and using accessory musclesPlethoric, barrel chest

Hands - Tar Staining, c02 flap

JVP - May be raised in cor pulmonale

Face - May show cyanosis

Trachea - Central but decreased distance

Expansion - reduced but hyperexanded

Percussion - Hyper resonant

TVF - Normal

Auscultation - Decreased breath sounds, widespread expiratory wheeze

Legs - Ankle swelling due to cor pulmonale due to RHF

Question 2

What are the investigations?

Answer 2

By the bed - History, obs, peak flow, cardiovascular exam, spirometry and sputum

Bloods - FBC (anaemia or infection), CRP for infection

Other - CXR, ECG, ABG for respiratory failure

Question 3

What are the key investigation findings?

Answer 3

Bloods - May be polycythaemic

CXR - Hyperexpansion, flattened diaphragms, increased lung markings

ABG - Type 1 or type 2 respiratory failure

Spirometry - Obstructive picture with low Fev1:FVC ratio (low Fev1, low or normal FVC)

Question 4

What is the treatment?

Answer 4

Conservative - education, smoking cessation and annual immunisations and oxygen at home. Regular reviews

Keep fit so exercise

Home rescue kits

Medical - Follow stepwise protocol so SABA/SAMA then depending on Fev1 escalate this

Question 5

What are causes of COPD

Answer 5

Smoking

Occupational - dust

Alpha 1 anti trypsin deficiency