COPD

Question 1

What is seen on spirometry?

Answer 1

Airway obstruction

FEV1/FVC <0.7

Question 2

What are the presentations of COPD and what is the difference?

Answer 2

Chronic bronchitis:
- Cough and sputum production of most days for 3m of 2 successive years

Emphysema:
- Histological dx of enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls

Question 3

Name 3 causes of COPD

Answer 3

• Smoking
• Pollution
• a1ATD - emphysema

Question 4

What are the features of COPD?

Answer 4

(Productive) cough
Dyspnoea
Wheeze
RHF in severe cases 
  - peripheral oedema 
Weight loss

Question 5

What is stage 1 COPD

Answer 5

Mild

FEV1 >80%

Question 6

What is stage 2 COPD

Answer 6

Moderate

FEV1 50-79%

Question 7

What is stage 3 COPD

Answer 7

Severe

30-49%

Question 8

What is stage 4 COPD

Answer 8

Very severe

<30%

Question 9

What are the signs?

Answer 9

Tachypnoea
Hyperinflation 
Wheeze
Early-inspiratory crackles 
Cyanosis
Cor pulmonale: high JVP, oedema, loud P2

Question 10

What are pink puffers?

Answer 10

Increased alveolar ventilation
= SOB but not cyanosed

Normal PaO2

Normal or low PaCO2

Progresses to T1RF

Question 11

What are blue bloaters

Answer 11

Reduced alveolar ventilation
= cyanosed but not SOB

Reduced PaO2

High PaCO2

Progresses into T2RF and cor pulmonale

Question 12

What IX are required?

Answer 12

Post-bronchodilator spirometry - irreversible obstruction

CXR

Bloods:

• FBC - exclude secondary polycythaemia
• A1AT
• ABG

BMI

ECG - R atrial hypertrophy, RVH

ECHO - RHF

Question 13

What is seen on CXR?

Answer 13

• Hyperinflation (>6 ribs seen ant.)

- Prominent pulmonary A

Question 14

How is it MX?

Answer 14

(1) SABA/ SAMA

If SOB continues but no asthmatic features:
- SABA + LABA + LAMA

If SOB continues and has asthmatic features:
- LABA + ICS
If SOB continues
- Triple therapy: LAMA + LABA + ICS

Oral theophylline - after trials of everything above/ cannot use inhaled therapy

Oral prophylactic abx in some pts

Mucolytics in pt with chronic productive cough

Loop diuretics and O2 - RHF

SMOKING CESSATION
Long-term O2 therapy in those who fit the criteria
Lung volume reduction surgery in some pts