COPD

Question 1

Define:

Answer 1

Chronic progressive lung disorder characterised by airflow obstruction with little/no reversibility.

Question 2

What are the two main conditions that make up COPD and their definitions?

Answer 2

Chronic Bronchitis - defined clinically. Chronic coughs with large amounts of sputum that occur almost everyday for 3 month for two years

Emphysema - defined histologically. Enlarged air spaces with destruction of the alveolar walls.

Question 3

What is the aetiology and risk factors of COPD?

Answer 3

Main risk factor is smoking.

Environmental toxins –> increased resistance to airflow and compliance of the lungs –> airflow obstruction which leads to air trapping as the lungs cannot empty properly.

Question 4

What is the aetiology of chronic bronchitis;

Answer 4

Irritant leads to hypertrophy and hyperplasia leads to an increased mucus production which leads to a mucus plug (this increases risk of infections)

Smoking also shortens the cilia so there is removal of mucus –> rely on coughing to remove the mucus plugs

There is an increase of PCO2 in the blood hence the blue bloaters name

Question 5

What is the aetiology of emphysema:

Answer 5

Enzymes break down the collagen and elastin in the lung which mean it is more likely to collapse due to the pressure and more likely to hyper-inflate (become very compliant)

Breathe through pursed lips hence the name pink puffers

Question 6

Epidemiology:

Answer 6

very common (8% prevalence)

In middle age or later usually

More common in males

Question 7

Symptoms:

Answer 7

Breathlessness

Wheeze

Chronic cough

decreased exercise tolerance

sputum production

Question 8

Signs:

Answer 8

respiratory distress

tripod position

pursed lips breathing

decreased cricosternal distance –> cyanosis

Barrel chest - hyperinflated chest

hyper-resonant chest on percussion + loss of liver and cardiac dullness

reduced chest expansion

reduced breath sounds

wheeze

prolonged expiratory phase

CO2 retention flap, warm peripheries + bounding pulse

Rhonchi - rattling, continuous and low-pitched breath sounds that sounds a bit like snoring. They are often caused by secretions in larger airways or obstructions

Sometimes crepitations

Question 9

what are signs of cor pulmonale as a complication:

Answer 9

raised JVP

right ventricular heave

ankle oedema

Question 10

Investigations:

Answer 10

spirometry + pulmonary function test –> increased lung volume, decreased PEFR and decreased FEV1/FVC

decreased CO gas transfer co-efficient

CXR –> dark lungs, hyperinflated lungs, flattened diaphragm, reduced peripheral lung markings, elongated cardiac silhouette

Bloods - FBC (Hb and Hct are increased)

ECG and echo - cor pulmonale investigations

a1-anti trypsin levels - suspect deficiency in a young person who has never smoked

Question 11

Management generally:

Answer 11

General:
stop smoking 
lose weight
increase exercise 
SABA (salbutamol) or SAMA (ipatromium bromide)

Add to the inhaler –>
if > 50% of predicted level then LABA (salmeterol)/LAMA (tiotropium)
if <50% then LABA + ICS/ LAMA

Question 12

Management of an acute exacerbation:

Answer 12

Oxygen - either by a mask or nasal cannula

Corticosteroid - prednisolone (oral) or hydrocortisone (IV)

Antibiotics

Bipap

Salbutamol (SABA)
Ipatromium bromide (SAMA)

Question 13

Complications:

Answer 13

cor pulmonale

respiratory failure

pneumothorax

infections

pulmonary hypertension

secondary polycythemia

Question 14

Prognosis:

Answer 14

High morbidity

90% mortality if <60 years and FEV1 >50% of predicted

75% mortality if >60 years and FEV1 <50% of predicted