COPD

Question 1

Name 2 causes of COPD

Answer 1

Smoking

Alpha 1 anti-trypsin deficiency

Question 2

What are some features of COPD?

Answer 2

Cough

Dyspnoea

Wheeze

Barrel chest due to hyperinflation

Right sided heart failure may result in the development of peripheral oedema

Question 3

What investigations would you order for a patient that you thought might have COPD?

Answer 3

Spirometry testing that would show little to no reversibility (FEV1:FVC <70%) post bronchdilator treatment.

CXR may show COPD changes

FBC: exclude secondary polycythaemia

BMI should be calculated

Question 4

How would you assess a COPD patient for their eligibility for LTOT?

Answer 4

Take 2 ABG’s from the patient at least 3 weeks apart.

LTOT is offered to those with partial pressures of <7.3kPa

LTOT is considered if the patients have a partial pressure of 7.3-8kPa with a symptom such as secondary polycythaemia, pulmonary oedema, or pulmonary hypertension.

LTOT is contraindicated in smokers

Question 5

What risks should be assessed when offering someone at home oxygen treatment?

Answer 5

Their risks of falls over the leads that will installed with the oxygen

Their risks of house fires

Their smoking risk

Question 6

In what patients should LTOT testing be considered?

Answer 6

Patients with any of the following:

Raised JVP

Cyanosis

Peripheral oedema

Polycythaemia

Oxygen saturations <92% on room air

Question 7

What is the general/conservative management in a patient who receives a COPD diagnosis?

Answer 7

• Smoking cessation
• Offer pneumococcal (one off) and influenza (annual) vaccinations
• Offer pulmonary rehabilitation to patients that consider themselves functionally disabled by COPD

Question 8

What is the first line pharmacological treatment for a patient with COPD?

Answer 8

• SABA
• LABA + LAMA should be added if no features suggesting steroid responsiveness (features of asthma)
• LABA + LAMA + ICS + SABA
• Offer oral theophylline to patients whom are unable to take inhalers or are not responding to inhalers.
• Consider azithromycin prophylaxis for exacerbations if the patients aren’t responding to therapy with routine ECG monitoring as it can prolong the QT interval.

Question 9

How does cor pulmonale present?

Answer 9

Peripheral oedema

Elevated jugular venous pressure

Systolic parasternal heave

Question 10

How would you manage cor pulmonale in a COPD patient?

Answer 10

Prescribe a loop diuretic

Consider LTOT