COPD

Question 1

Clinical signs

Answer 1

Nebuliser, oxygen, central cyanosis, dyspnoea, pursed lips
CO2 retention flap
Hyperexpanded chest, Percussion resonant with loss of cardiac dullness
Exploratory polyphonic wheeze
Cor pulmonale
COPD does not cause clubbing so if present other cause: bronchiectasis or bronchial Ca

Question 2

Causes of apical vs basal COPD

Answer 2

Apical: smoking, industrial dust
Basal: alpha1-antitrypsin deficiency

Question 3

Ixs

Answer 3

CXR: hyperexpanded and/or pneumothorax
ABG: Type 2 respiratory failure
Bloods: WCC, low alpha 1 antitrypsin (young/fit), albumin (severity)
Spirometry: FEV1/FVC <0.7

Question 4

Treatment of COPD

Answer 4

Medical:
Stop smoking, smoking cessation therapy, LTOT, beta agonists (mild FEV1>80), +tiotropium (moderate FEV1<60), +inhaled steroids (severe FEV1<40). Do not use steroids if any history of pneumonia. Exercise, nutrition, vaccinations (flu, pneumococcal).

Surgical: bullectomy if Bullae>1L and compressing lung, endobronchial valve, single lung transplant, lung reduction surgery.

Question 5

Criteria for LTOT

Answer 5

Non smoker
Pa02 <7.3 on air, if evidence of cor pulmonale <8.0
PaCO2 does not rise excessively when on O2
2-4L/min at least 15h a day
Improves survival by 9 months

Question 6

Tx of acute exacerbation of COPD

Answer 6

O2 via Venturi, closely monitored
Bronchodilators
Abx
Steroids 7 days

Prognosis: IECOPD has 15% hospital mortality

Question 7

DDx of “COPD” wheezy chest:

COPD

Answer 7

Granulomatous polyarteritis (Wegeners): saddle nose, obliterative bronchitis
Obliterative bronchitis in RhA
Post lung transplant: obliterative transplant as spectrum of rejection