COPD

Question 1

Signs of COPD

Answer 1

Expiratory wheeze
Tachypnoea
Use of accessory muscles
Pursed lip breathing
Barrel chest 

Severe: cyanosis, raised JVP, CO2 retention tremor, cor pulmonale

Question 2

Causes of COPD

Answer 2

Smoking
Alpha-1-antitrypsin deficiency
Occupational exposure - coal dust, pollution

Question 3

Define COPD

Answer 3

Chronic airflow obstruction, slowly progressing, not fully reversible, does not change markedly over several months

Question 4

Symptoms of COPD

Answer 4

Productive cough (white sputum)
Wheeze
Breathlessness

Question 5

Pathophysiology of COPD

Answer 5

Emphysema: destruction of terminal bronchioles and alveoli leads to impaired gas exchange. Destruction of supporting tissue decreases radial traction and means the small airways close in expiration, leading to airway obstruction.

Bronchitis: chronic inflammation of the large airways leads to mucus hypersecretion and airway remodelling and narrowing.

Question 6

Investigations of COPD

Answer 6

CXR - hyperinflated lungs (over 7 anterior ribs in lung field and flattening of the diaphragm)
Spirometry - FEV1/FVC ratio <70%
FBC - anaemia
Blood gas - low pO2, high pCO2
Alpha-1-antitrypsin
MRC Dyspnoea score

Question 7

Management of COPD

Answer 7

Smoking cessation, pulmonary rehabilitation

Pharmocological therapy: reduces exacerbation frequency but doesn't improve survival/progression
Short acting B2-agonist eg. Salbutamol 
Inhaled corticosteroids 
Long acting B2-agonist 
Long acting muscarinic antagonist 

Long term oxygen therapy

Question 8

ADRs of corticosteroids

Answer 8

Sore throat
Cough
Increased risk of pneumonia
Thinning of skin, bruises easily

Question 9

Complications of COPD

Answer 9

Recurrent pneumonia
Pneumothorax
Respiratory failure
Cor pulmonale

Question 10

COPD differential diagnosis

Answer 10

Asthma
Bronchiectasis
Alpha-1-antitrypsin deficiency
Heart failure