COPD

Question 1

What is COPD?

Answer 1

non-reversible, long term deterioration in air flow through the lungs caused by damage to lung tissue

Question 2

What is the main cause of COPD?

Answer 2

smoking

Question 3

Does salbutamol reverse obstruction?

Answer 3

No - only do in asthma

Question 4

Presentation of COPD

Answer 4

smoker

SOB, cough, sputum, wheeze, recurrent respiratory tract infections

Question 5

other diagnoses to consider

Answer 5

lung cancer, heart failure and fibrosis

Question 6

does COPD cause clubbing?

Answer 6

No

Question 7

Does COPD cause haemoptysis or chest pain?

Answer 7

neither

Question 8

5 point scale for breathlessness

Answer 8

1 = SOB strenuous exercise
2 = walking up hill
3 = SOB that slows walking on flat
4 = stop to catch breath after 100m on flat
5 = unable to leave house

Question 9

diagnosing COPD

Answer 9

clinical picture and spirometry

Question 10

FEV1/FVC ratio

Answer 10

<70%

Question 11

severity of COPD based on FEV1

Answer 11

stage 1 = >80%
stage 2 = 50-79%
stage 3 = 30-49%
stage 4 = <30%

Question 12

other investigations

Answer 12

CXR
FBC - polycythaemia
sputum culture 
ECG and echo
CT thorax 
serum alpha 1 antitrypsin
transfer factor for carbon monoxide

Question 13

long term management

Answer 13

stop smoking 
pneumococcal and flu vaccine
SABA or SAMA
LABA and LAMA (anoro)
LABA and ICS (fostair)
LABA and LAMA and ICS (asthmatic features) - trimbo

Question 14

Other management strategies

Answer 14

nebulisers - salbutamol/ipratropium
oral theophylline 
oral mucolytic
long term prophylactic antibiotics 
long term oxygen

Question 15

Indications for long term oxygen therapy

Answer 15

chronic hypoxia
polycythaemia
cyanosis
heart failure secondary to pulmonary hypertension

Question 16

what is heart failure secondary to pulmonary hypertension known as?

Answer 16

cor pulmonale

Question 17

Important thing to remember with long term oxygen therapy

Answer 17

cannot be used if smoke - fire hazard

Question 18

How does an exacerbation present?

Answer 18

acute worsening of symptoms - cough, SOB, sputum and wheeze

Question 19

what triggers exacerbations?

Answer 19

usually viral or bacterial infection

Question 20

exacerbation investigation

Answer 20

ABG

Question 21

ABG - exacerbation

Answer 21

respiratory acidosis

raised bicarbonate = chronic retain co2 and kidneys responded

Question 22

type 1 resp failure

Answer 22

low pO2 with normal pCO2

Question 23

type 2 resp failure

Answer 23

pO2 and PCO2 low

Question 24

Other investigations - exacerbation

Answer 24

CXR, FBC, U and E
ECG
sputum culture
blood cultures if septic

Question 25

oxygen and COPD

Answer 25

too much oxygen can depress respiratory drive and leads to more CO2 retention

Question 26

oxygen general rules in COPD

Answer 26

retaining CO2: sats aim 88-92% titrated by venturi mask

not retaining and bicarbonate normal aim >94%

Question 27

medical treatment of exacerbation

Answer 27

prednisolone 30mg 1 daily 
regular inhalers/nebulisers
antibiotics 
nebulised bronchodilators
IV aminophylline/NIV/intubation 
doxapram