COPD

Question 1

What is the usual appearance of a COPD patient secondary to chronic bronchitis?

Answer 1

Overweight and oedematous, cyanosed by not usually breathless.

‘Bronchitis = Blue Bloater’
(all the B’s)

Question 2

What is the usual appearance of a COPD patient secondary to emphysema?

Answer 2

Thin, wasted with pursed lips, minimal cough, breathless but not usually cyanosed.

‘emPhysema = Pink Puffer’
(all the P’s)

Question 3

What are the criteria a patient must meet to be diagnosed with chronic bronchitis?

Answer 3

Productive cough for 3 months or more in two consecutive years.

Question 4

How is a histological diagnosis of emphysema made?

Answer 4

Dilatation of air spaces distal to terminal bronchioles with destruction of alveolar walls (often visualized on CT)

Question 5

True or false: Emphysema typically progresses to cor pulmonale.

Answer 5

False, chronic bronchitis (blue bloaters) typically progresses to cor pulmonale. Emphysema typically progresses to type I respiratory failure.

Question 6

What is the number one cause of COPD?

Answer 6

Smoking

Question 7

Other than smoking, what other things can cause COPD?

Answer 7

Air pollution

Occupational exposure

alpha-1 antitrypsin deficiency

Question 8

True or false: Smoking typically cause centrilobar/centriacinar emphysema; A1AT deficiency typically causes panlobular/panacinar emphysema.

Answer 8

True

Two Types of Emphysema:

• Centrilobular/Centriacinar (respiratory bronchiole): smoking, primarily affects upper lung zones.
• Panlobular/Panacinar (all parts of acinus): a-1-antitrypsin deficiency, primarily affects lower lobes; around 1% of emphysema cases.

Question 9

What symptoms might you expect to hear from a COPD history?

Answer 9

Chronic productive cough

Progressive dyspnoea

Fatigue (coughing disrupts sleep)

Symptoms of infection if infective exacerbation

Question 10

What signs might you expect to find on examination of a patient with COPD?

Answer 10

General inspection: tachypnoea; cyanosis; use of accessory muscles of respiration

Inspection: barrel chest (classic), JVD

Palpation: ↓ expansion (but hyperinflation on CXR); ↓ cricosternal distance (<3cm)

Percussion: resonant or hyper-resonant

Auscultation: end-expiratory wheeze; quiet/muffled breath sounds (e.g. over bullae); poor air movement.

Question 11

What differentials might you consider alongside COPD?

Answer 11

• Asthma
• Congestive heart failure
• Pulmonary oedema
• Bronchiectasis
• Upper airway dysfunction

Tuberculosis

Bronchiolitis

Chronic sinusitis/postnasal drip

Gastro-Oesophageal Reflux Disease (GORD)

ACE inhibitor

Lung cancer

Question 12

What score(s) can be used to classify severity of COPD?

Answer 12

BODE

• BMI
• Obstructed airway
• Dyspnoea
• Exercise capacity

Question 13

How would you investigate COPD?

Answer 13

Spirometry (reduced FEV1 and FEV1/FVC ratio)

PulseOx

ABG (↓ PaO₂ (<60 mmHg) ± ↑PaCO₂ (>50 mmHg)

CXR (Hyperinflation; flat hemidiaphragms)

FBC

ECG (signs of cor pulmonale, also IHD is a common comorbidity due to shared risk factors)

Question 14

How is COPD managed?

Answer 14

**Smoking cessation

Pneumovax

Bronchodilators (S/LABAs and S/LAMAs) and corticosteroids

Supplemental O2