COPD

Question 1

What does COPD consist of?

Answer 1

• airflow obstruction: Chronic Bronchitis - not fully reversible: but some reversibility can be produced by bronchodilator therapy
• hyperinflation: emphysema –> air exchange becomes difficult in alveoli and air becomes trapped

Question 2

what are the main symptoms of COPD?

Answer 2

Breathlessness -because of airflow obstruction. Starts with only exertional but severity may increase

Cough- because of airway inflammation

• long history of smoker’s cough
• clear or mucoid sputum

Wheeze- typically on exertion
Chest tightness

Question 3

why do people develop COPD?

Answer 3

95% of people who develop COPD are smokers

Question 4

when should you suspect COPD?

Answer 4

• age 35 and over

- current or former smokers

Question 5

what are some causes of COPD?

Answer 5

• chronic asthma
• passive smoking
• occupation (dust, vapour, fumes)
• air pollution
• a-1-antitrypsin deficiency

Question 6

what are signs of COPD?

Answer 6

• hyper expanded chest; reduced expansion
• prolonged expiration/wheeze
• respiratory failure - severe
• breathless walking into clinic
• pursed lip breathing, use of accessory muscles
• peripheral oedema
• cyanosis (discolouration of skin due to poor oxygenation of the blood)
• tachypnoea
• co2 flap (sign of co2 retention)

Question 7

what investigations should be done to diagnose COPD?

Answer 7

• Spirometry
• Lung Volumes
• CO gas transfer
• CXR - hyper inflated lung fields/ flattened diaphragms/ lucent lung fields/ bullae)
• ECG
• Bloods; FBC- secondary polycythaemia
• BMI
• blood gases (type I/type II respiratory failure)
• sputum - bacteria

Question 8

how do you assess minimum bronchodilator reversibility with COPD?

Answer 8

baseline, 15 mins post neb 2.5-5mg Salbutamol (SABA)

baseline, 30 mins post neb 2.5-5mg Salbutamol + 500mcg ipratropium (SAMA)

Question 9

how do you assess minimum response to oral corticosteroids ?

Answer 9

30-40mg Prednisolone daily for 2 weeks (0.6mg/kg)

measure baseline and final FEV1

Question 10

how do you interpret reversibility?

Answer 10

if significant reversibility (FEV1 >15% baseline) suggests asthma/asthmatic component
COPD: insignificant bronchodilator/steroid response

Question 11

When do you give long term oxygen therapy?

Answer 11

-Pa02 <7.3 kPa 
OR 
-Pa02 7.3-8kPa if have below symptoms:
-polycythaemia 
-nocturnal hypoxia
-peripheral oedema 
-pulmonary hypertension

Question 12

what are symptoms of Acute Exacerbation COPD?

Answer 12

• increasing breathlessness
• cough
• sputum volume
• sputum purulence
• wheeze
• chest tightness

Question 13

what is the management of AECOPD

Answer 13

steroids:
-prednisolone 40mg x day 5-7 days 
antibiotics 
SABA 
hospital admission if v unwell- tachypnoea, low o2 saturation, hypotension