COPD

Question 1

What is COPD

Answer 1

-An obstruction of the airways due to chronic bronchitis: thick/stick mucus clogs up the airways and inflammation/swelling of the bronchiole walls restricts it further
AND/OR
-Emphysema: destruction of the alveoli which are the site of gas exchange

Question 2

Symptoms of COPD

Answer 2

1- breathlessness
2-chonic winter bronchitis
3-production of sputum 
4-persistant cough
and 
weight loss/muscle loss
cardiac disease
anxiety/depression

Question 3

difference asthma/COPD

Answer 3

asthma : age-any
cough-intermittant and variable
nocturnal symptoms 
almost always accompanied by eczema and night rashes 
breathlessness- intermittent
Family history-common 
 COPD: 
age-over 35
cough- persistent
Breathless- persistent 
Smoker-almost always

Question 4

Examination

Answer 4

hyperinflated chest 
reduced chest expansion 
when respiratory failure: 
-tachypnea-abnormal reduced breathing 
-cyanosis-blue discoloration due to reduced 02 saturation 
pursued lip breathing 
use of accessory muscles 
peripheral oedema

Question 5

Diagnosis

Answer 5

Clinical history e.g. cough
Examination
Spirometry- in COPD REDUCED FEV and/or FVC

Question 6

Non-pharmalogical management

Answer 6

1- Smoking cessation 
2-Vaccination 
3-Pulmonary rehabilitation 
4-nutritional assessment 
5-psycological support

Question 7

Pharmacological management

Answer 7

inhalers:
- SABA/SAMA:
- LAMA/LABA
- ICS: inhaled corticosteroids

When treating from better to worse FEV1:
1- LABA/LAMA
2-increase dosage of LABA/LAMA
3- triple action of LABA/LAMA and ICS

Question 8

When to give long term 02

Answer 8

• Give to patients with Pa02 of 7.3 Kpa or less

- Pa02 between 7.3 and 8 Kpa and nocturnal hypoxia, peripheral oedema, pulmonary hypotension, polycythemia

Question 9

How to deal with AECOPD

Answer 9

• SABA/ salbutamol or Ipratropium. use nebulisers if inhalers not possible
• Steroids
• Antibiotics if infection present
• Hospital admission: if tachypnoea, hypotension, low 02 sats<90