COPD

Question 1

What is COPD?

Answer 1

Chronic disorder of airflow obstruction

Question 2

What conditions make up COPD?

Answer 2

Emphysema and chronic bronchitis

Question 3

What is emphysema?

Answer 3

Enlarged airspaces due to alveolar wall destruction - loss of elastin due to increased protease activity

Question 4

What are features of chronic bronchitis?

Answer 4

Cough with sputum production most days for 3 months in 2 successive years

Question 5

What is the pathophysiology of COPD?

Answer 5

Mucous gland hyperplasia
Loss of cilia
Chronic inflammation
Fibrosis of small airways

Question 6

What causes COPD?

Answer 6

Smoking
Occupational exposure
α-1-antitrypsin deficiency

Question 7

What are symptoms of COPD?

Answer 7

Cough
Dyspnoea
Wheeze

Question 8

What do you find on examination of COPD?

Answer 8

Barrel chest
Decreased chest expansion 
Hyper resonant percussion 
Reduced breath sounds
Inspiratory crackles

Question 9

What is the spirometry pattern?

Answer 9

Obstructive

FEV1 < 80% of predicted
FEV1/FVC <0.7

Question 10

How is COPD classified?

Answer 10

Mild - FEV1 50-80% of predicted

Moderate - FEV1 30-49%

Severe - FEV1 <30%

Question 11

How do you manage COPD conservatively?

Answer 11

Smoking cessation
Weight loss
Influenza vaccinations
Pulmonary rehabilitation

Question 12

How do you manage mild COPD?

Answer 12

Anti-muscarinic PRN

B2 agonist PRN

Question 13

How do you manage moderate COPD?

Answer 13

Regular anti-muscarinic OR LABA

+/- inhaled corticosteroid

Question 14

How do you manage severe COPD?

Answer 14

Regular SABA

Anticholinergic

Question 15

When is Long term oxygen therapy offered?

Answer 15

pO2 consistently <7.3
Non-smoker
Not retain CO2

Question 16

How do you classify barrel chest on an x-ray?

Answer 16

> 8 anterior ribs OR >10 posterior ribs

Question 17

How do you evaluate baseline?

Answer 17

MRC dyspnoea scale

COPD assessment test

Question 18

What is the MRC dyspnoea scale?

Answer 18

1 Not troubled by breathless except on strenuous exercise
2 Short of breath when hurrying on a level or when walking up a slight hill
3 Walks slower than most people on the level, stops after a mile or so, or stops after 15 minutes walking at own pace
4 Stops for breath after walking 100 yards, or after a few minutes on level ground
5 Too breathless to leave the house, or breathless when dressing/undressing

Question 19

What is the COPD assessment test?

Answer 19

Tool to assess how COPD affects every day life

Cough 
Phlegm 
Walking 
Daily activities
Leaving house
Sleep 
Energy