COPD

Question 1

COPD

Answer 1

Progressive respiratory diesease
Airflow is obstructed
Abnormal inflammatory response
Not fully reversible

Question 2

Risk Factors COPD

Answer 2

Smoking (90% cases)
Smoky fuels 
Air pollution 
Occupational Exposure
Low Socio-Economic Group
Alpha 1 Antitrypsin defficiancy

Question 3

COPD Pathophysiology

Answer 3

Increased Goblet Cells -> increased bronchial mucous
Acute and Chronic inflammatory lymphocytic infiltrates
Ulceration of respiratory epithelium
Columnar cells replaced by squamous cells
Scarring and thickening of brochial walls
emphysema: Chronic enlargement of distal air spaces with reduced elastic recoil

Question 4

Symptoms COPD

Answer 4

Productive Cough with clear/ white sputum
Wheeze
SOB
Colds which "settle on chest"
Recurrent Chest Infections
Reduced exercise tolerance

Question 5

Signs COPD

Answer 5

Wheeze
Tachypnoeic
Prolonged Expiratory phase
Accessory Muscle use
Indrawring intercostal space
persed lips
reduced chest expansion
Hyperinflation
Hypercapnic: Vasodilated Bounding pulse, coarse flapping tremor, Pink
Cor Pulmonale: cyanotic fluid overload

Question 6

Investigations COPD

Answer 6

Spirometry: Low FEV1:FVC
Low Peak flow
Normal / increased Lung volume

CXR: Normal / Hyperinflation (low flattened diaphragm with large bullae) / pruned blood vessells

Bloods: FBC polycythemia secondary to chronic hypoxia / High Hb / High PCV

Question 7

Management COPD in community

Answer 7

1. Smoking cessation
2. Medication: Antimuscarinics (ipratropium) B Adronergic Agonists (Salbutamol/ Formeterol)
3. 2 week trial of oral pred - give inhaled steroids if improvment
4. Trial Carbocysteine
5. Alpha-1-antitrypsin replacment
6. Symptomatic releif Benzo/ Opiate
7. prophylactic antibiotics
8. Vaccinations Flu annual and pnumococcal

Question 8

What are COPD exacerbations?

Answer 8

Viral / Bacterial RTI acute worsening in symptoms

Identified by:

1. Increased SOB
2. Increased Sputum production
3. Sputum purulance

Question 9

Management acute exacerbation of COPD

Answer 9

O2 Venturi 24% and titrate up (until sats 88-92% / PO2 >8)

Nebulised Bronchodilators (SABA and Antimuscarinics)

Oral Pred

Co-Amoxiclav + Cefaclor

Consider for NIV

Aminophylline

Physio and rehab

Question 10

Mortality prediction BODE

Answer 10

BMI
Obstuction (FEV1)
Dyspnoea
Exercise capacity

Question 11

End Stage COPD

Answer 11

Involve pulmonary rehab early- imrpved quality of life but not length
Evaluate for home O2/ O2 for air travel
Surgical involvment: Bullectomy / Lung reduction / Single lung transplant
Palliative care

Question 12

Gold Criteria COPD stages

Answer 12

1. Mild: >80% pred FEV1:FVC asymptomatic or chronic cough
2. Moderate: 50-80% predicted. SOB on Exertion
3. Severe: 30-50% SOB on minimal activity, weight loss and depression
4. <30% (or 50%+RF) Breathless at rest