COPD

Question 1

What is COPD

Answer 1

Progressive airway obstruction (FEV1<80%, FEV1/FVC<0.7) with little/no reversibility
Includes chronic bronchitis + emphysema

Question 2

What is chronic bronchitis

Answer 2

Clinically diagnosed cough, sputum production on most days for 3 mths of 2 successive years

Question 3

What is emphysema

Answer 3

Histologically enlarged air spaces distal to terminal bronchioles, with alveolar wall destruction
Often visualised on CT

Question 4

COPD patient types

Answer 4

Pink puffers - inc alveolar ventilation, breathless but not cyanosed with normal PaO2 and low PaCO2
Blue bloaters - cyanosed, dec alveolar ventilation, high PaCO2 and low PaO2 so hypoxic resp drive

Question 5

COPD signs + symptoms

Answer 5

Cough sputum
Dyspnoea, wheeze
Decreased chest expansion
Cricosternal distance <3cm

Question 6

COPD complications

Answer 6

Acute exarcebations + infections
Cor pulmonale (oedema + raised JVP)

Resp failure
Pneumothorax

Lung carcinoma

Question 7

COPD tests

Answer 7

FBC shows inc PCV
CXR shows hyperinflation, flat hemidiaphragms, large central pulmonary arteries, bullae
CT shows air space enlargement and bronchial wall thickening
Spirometry - inc RV, TLC and obstructive pattern

Question 8

General treatments COPD

Answer 8

Smoking cessation
Encourage exercise
Pulmonary rehab offered early when ADLs affected

Mucolytics
Diuretics for oedema
Flu + pneumococcal vaccines

Question 9

Use of LTOT

Answer 9

Long-term O2 therapy (PaO2 maintained >8 for 15/24h), used for:

Clinically stable non-smokers with PaO2<7.3 despite max treatment
PaO2 7.3-8 and pulmonary HT/ polycythaemia/ peripheral oedema/ nocturnal hypoxia
O2 for terminally ill pts

Question 10

COPD severity assessment

Answer 10

All have FEV1/FVC <0.7

Mild - FEV1 >80% with symptoms
Moderate - FEV1 50-79%
Severe - FEV1 30-49%
Very Severe - FEV1 <30%

Question 11

COPD management

Answer 11

SABA/SAMA PRN

If steroid responsiveness then LABA + inhaled corticosteroid

If no steroid responsiveness then LABA + LAMA

LAMA/ICS added if still symptomatic

Azithromycin 250mg 3x per week added if not smoking and >4 exarcebations per year

Question 12

COPD specialist referral indications

Answer 12

Uncertain diagnosis/ suspected severe/ rapid FEV1 decline
Symptoms disproportionate to lung function tests

Cor pulmonale
Bullous lung disease
Frequent infections (to exclude bronchiectasis)

<10 pack years/ <40yrs

Question 13

COPD emergency management principles

Answer 13

Ensure oxygenation, treat reversible cause
Start with 24-28% if CO2 retention evidence (blue bloaters), if no evidence then still 28-40% O2 but monitor ABG
ABG within 1h once started O2, aim for PaO2>8 with PaCO2 rise < 1.5

Question 14

COPD emergency management protocol

Answer 14

Salbutamol 5mg/4h + ipratropium 500µg/6h
O2 therapy, aim for sats 88-92%
IV hydrocortisone 200mg + pred 30mg/d PO for 7-14d

Abx if infection evidence
Physio for sputum expectoration

IV aminophylline if no response to Rx

NIPPV or doxapram 1.5-4mg/min IV (to boost resp if NIV unavailable) if still no response
Intubate + ventilate if pH <7.26 + PaCO2 rising

Question 15

COPD diagnosis criteria

Answer 15

FEV1/FVC post-bronchodilator <70% in addition to:

symptoms of COPD
or
FEV1<80%

Question 16

Azithromycin treatment starting requirements

Answer 16

Non-smoker
≥4 exacerbations per year
ECG to check no long QT
Baseline LFTs