COPD

Question 1

Define COPD?

Answer 1

A chronic and slowly progressive disorder of airway obstruction that shows little change over months, largely irreversible and commonly includes emphysema and chronic bronchitis.

Question 2

What are the symptoms of COPD?

Answer 2

Wheeze
Cough
Sputum
SOB
Fatigue
Weightloss/MuscleLoss

Question 3

Signs of COPD?

Answer 3

• Hyperinflated Chest
• Reduced Breath Sounds
• Reduced dullness to percussion/hyperresonance
• Pursed lip breathing & accessory muscles
• Reduced chest expansion
• Cyanosis
• Cor Pulmonale -> Peripheral Oedema/Fatigue

Question 4

How is COPD investigated?

Answer 4

FBC: May see rise in haematocrit due to polycythaemia
CXR: Bullae, Hyperinflation, loss of peripheral lung markings/lucent lung fields, flat diaphragm

PFT: Helium Dilution & CO transfer

Spirometry: Lower FEV1/FVC

ECG: Cor Pulmonale (right heart hypertrophy)

O2 Sat & ABG: Lower PaO2 & higher PaCO2.

Question 5

How do we manage COPD?

Answer 5

Smoking Cessation - Weight Loss - Exercise - Influenza/Pneumoccocal Vaccinations - Pulmonary Rehab

• Mucolytics
• SABA
• LAMA & LABA
• Inhaled and/or oral corticosteroids
• LTOT
• Diuretics if cor pulmonale

Question 6

What is an acute exacerbation of COPD?

Answer 6

A worsening of symptoms brought on by infection, sedative meds or enviromental pollution

Question 7

How do we investigate an acute exacerbation of COPD?

Answer 7

ABG
CXR: Exclusion of pneumothorax etc
FBC + U&E + CRP
ECG
Blood or Sputum cultures if relavent

Question 8

How do we treat an acute exacerbation of COPD

Answer 8

Antibiotics if necessary
Nebulised Bronchodilators (SABA/SAMA)
Oral & IV CCS
Controlled O2 therapy
IV Aminophylline
NIPPV or maybe intubation and ventilation

Question 9

what is a genetic cause for COPD, how do we check for it and treat it?

Answer 9

Alpha-1-antitrypsin deficiency
Can do a blood test to check, especially if family history.
Treat with alpha-1-antitrypsin replacement.