COPD

Question 1

Characterisation of COPD

Answer 1

An obstructive pulmonary disease with chronic obstruction of airflow that interferes with normal breathing and is not fully reversible. Usually caused by noxious particles or gases. Can include emphysema and hyperinflation

Question 2

Causes of COPD

Answer 2

Smoking.

Some occupations and AAT deficiency also. Often lower socioeconomic status, asthma, chronic bronchitis, childhood infection

Question 3

Alpha-1 antitrypsin deficiency

Answer 3

Rare and inherited. Alveolar damage and emphysema especially in basal areas

Question 4

Smokers chance of COPD and effects in pregnancy

Answer 4

<50% develop COPD. In pregnancy can affect foetal lung growth and priming of immune system

Question 5

Initial presentation of COPD

Answer 5

Varied, shortness of breath, chest infections, ongoing cough, wheeze, sputum. Less common is weight loss, fatigue, decreased exercise tolerance, ankle swelling/ cor pulmonale

Question 6

Examination findings of COPD

Answer 6

Cyanosis, raised JVP, cachexia (weight loss), wheeze, pursed lip breathing, hyperinflated chest, use of accessory muscles, peripheral oedema.

Question 7

mMRC dyspnoea scale

Answer 7

0-4 (breathlessness)

Question 8

Spirometry of COPD

Answer 8

Not used often, FEV1/FVC<0.7 post bronchodilator to demonstrate lack of reversibility.

Question 9

Prevalence of COPD

Answer 9

2% of the population, but 50% undiagnosed. Second most common lung disease after asthma

Question 10

Differentiating from other lung disease

Answer 10

Slowly progressive symptoms, smoking history, FEV1/FVC<70%. Common productive cough, persistent symptoms. More residual volume. Can use high res CT - upper zone emphysema

Question 11

Acute exacerbations symptoms and management

Answer 11

Can’t smoke, fatigue, temperature, all lung symptoms. Manage by changing inhalers, oral steroids, antibiotics

Question 12

Secondary care exacerbation symptoms and treatment

Answer 12

Confusion, cyanosis, breathless, flapping tremor, drowsy, pyrexia, wheeze, tripod position. Give oxygen and bronchodilators and oral steroids (treating what’s making it worse)

Question 13

how to measure severity of COPD

Answer 13

Spirometry, MRC breathlessness scale and COPD assessment tool, history of hospitalisation and co-morbidities

Question 14

Cor pulmonale and symptoms

Answer 14

Tachycardia, oedema and congested liver. Right side of heart hypertrophies

Question 15

Secondary polycythaemia

Answer 15

More erthrythropoeitin in response to low O2 so more RBC and thicker blood

Question 16

Severity by FEV1

Answer 16

≥80% predicted is mild
50-79% is moderate
30-49% is severe
<30% is very severe

Question 17

Benefits of pharmacological management eg inhalers

Answer 17

Relieves symptoms, prevents exacerbations, improves quality of life

Question 18

Short acting bronchodilators

Answer 18

SABA eg Salbutamol

SAMA eg ipratropium

Question 19

Long acting bronchodilators

Answer 19

LABA eg salmeterol

LAMA eg umeclidinium

Question 20

High dose inhaled corticosteroids

Answer 20

Relvar (fluticasone)

Fostair MDI

Question 21

Long term oxygen indications

Answer 21

If PaO2<7.3kPa or <8 if polycythaemia, nocturnal hypoxia, peripheral oedema, pulmonary hypertension

Question 22

Target O2 saturation

Answer 22

88-92%

Question 23

Ward based management in an exacerbation

Answer 23

Oxygen, nebulised bronchodilators, corticosteroids, antibiotics, assessment for respiratory failure