COPD

Question 1

COPD definition

Answer 1

Airway obstruction: chronic bronchitis + emphysema

Question 2

Chronic Bronchitis def

Answer 2

cough and sputum production

on most days

for 3 months of 2 successive years

Question 3

Emphysema def

Answer 3

histological diagnosis of enlarged airspaces distal to terminal bronchioles

Question 4

Spirometry results of COPD

Answer 4

FEV1 <80%,

FEV1:FVC <0.702

↑TLC

↑RV

Question 5

Causes of COPD

Answer 5

Smoking

Pollution

alpha1 antitrypsin deficiency

Question 6

Signs of COPD

Answer 6

Tachypnoea

Added sounds

Hyperinflation

Cyanosis

Cor pulmonale

Question 7

Auscultation of COPD

Answer 7

Prolonged expiratory phase

Wheeze

early-inspiratory crackles

Question 8

Signs of hyperinflation

Answer 8

↓Cricosternal distance (normal = 3 fingers)

Loss of cardiac dullness

Displaced liver edge

>6 ribs anteriorly on CXR

Question 9

Signs of cor pulmonale

Answer 9

↑JVP

oedema

Question 10

Respiratory failure in COPD

Answer 10

Pink Puffers - emPhysema - type 1 respiratory failure

Blue bloaters - Chronic Bronchitis - type 2 resp failure

Question 11

mMRC dyspnoea score

Answer 11

1. Dyspnoea only on vigorous exertion
2. SOB on hurrying or walking up stairs
3. Walks slowly or has to stop for breath
4. Stops for breath after <100m / few min
5. Too breathless to leave house or SOB on dressing

Question 12

Complications of COPD

Answer 12

Acute exacerbations ± infection

Polycythaemia

Pneumothorax (ruptured bullae)

Cor Pulmonale

Lung carcinoma

Question 13

ECG for COPD

Answer 13

R atrial/ventricular hypertrophy

Question 14

Severity of COPD

Answer 14

Mild: FEV1 >80% (but FEV/FVC <0.7 and symptomatic)

Moderate: FEV1 50-79%

Severe: FEV1 30-49%, Very Severe: FEV1 < 30%

Question 15

Conservative Treatment of COPD

Answer 15

Stop smoking

Mucolytics: carbocisteine

Question 16

Inhaled therapy algorithm for COPD

Answer 16

SOB or exercise limitation: SABA or SAMA

Persistant SOB or Exacerbation: depends on FEV1 (LABA/LAMA or LABA +ICS/LAMA)

Persistant exacerbation: LAMA and LABA+ICS

Question 17

O2 therapy for COPD

Answer 17

Long term O2 therapy Aim: PaO2 ≥8 for ≥15h / day

(↑ survival by 50%)

Question 18

Surgery for COPD

Answer 18

Recurrent pneumothoraces

Lung volume reduction

Question 19

Treatment of acute exacerbation

Answer 19

1. Controlled O2 therapy: SpO2-88-92%
2. Nebulised bronchodilators: salbutamol or ipratropium
3. Steroids: hydrocortisone IV and prednisolone PO
4. Abx if sign of infection doxycycline
5. Non invasive ventilation if no response