COPD

Question 1

What is COPD?

Answer 1

Chronic obstructive pulmonary disease is a long term and irreversible condition of the lungs.

Damage to tissue of bronchioles, fails to clear mucus, airways become obstructed and narrows so airflow is restricted.

Question 2

Causes of COPD?

Answer 2

Cigarette smoking most common cause of COPD, other can be dust or pollution.

Question 3

Risk factors for COPD?

Answer 3

Smoking, increased age, passive smoking, genetics (Alpha-1-antitrypsin deficiency)

Question 4

What symptoms do you suspect in someone with COPD in a long term smoker?

Answer 4

Progressively worse cough, sputum production, recurrent infections

Question 5

What signs would you find in a patient with COPD?

Answer 5

Tar staining on fingernails, tachypnoea, barrel chest, hyper-resonance on percussion (due to hyperinflation).

Question 6

What are the differentials for COPD?

Answer 6

Asthma - allergen/pollutant trigger, early in life, FHx, atopic dermatitis

Bronchiectasis - significant sputum production, CT chest bronchial dilation.

Question 7

What investigations would be needed for COPD?

Answer 7

Spirometry - can show an obstructive picture

FEV1/FVC ratio <0.7

Stage 1: FEV1 >80% of predicted
Stage 2: FEV1 50-79% of predicted
Stage 3: FEV1 30-49% of predicted
Stage 4: FEV1 <30% of predicted

CXR - exclude lung malignancy, shows hyperinflation, flattened diaphragm, consolidation from pneumonia

ABG - hypoxia, hypercapnia, Type 2 respiratory failure, respiratory acidosis with partial metabolic compensation (acute onset).

ECG - exclude ischaemic heart disease (Similar RF)

Question 8

What is FVC, FEV1?

Answer 8

FVC - forced vital capacity is amount of air forcibly expelled after a deep breath

FEV1 - forced expiratory volume in 1 second is the amount of air forcibly expelled in one second.

In COPD
FEV1/FVC ratio <0.7

Question 9

What should be offered for COPD patients?

Answer 9

Smoking cessation
Annual influenza vaccination
One of pneumococcal vaccinations

Question 10

What is emergency management of acute exacerbation of COPD?

Answer 10

Sit up in bed of SOB

O2: target saturations (88-92%), consider venturi mask 24% 4L or 28% 4L

Short acting beta-2 agonist – nebulised salbutamol (5mg)

Short acting muscarinic antagonist – nebulised ipratropium

Oral corticosteroids – oral prednisolone (30mg)

Failure of above interventions consider NIV with senior specialist

Investigations: CXR, sputum culture, ABG

Question 11

What is long term Mx for COPD?

Answer 11

1)Initial treatment: (SABA or SAMA as needed)
SABA – salbutamol, SAMA - ipratropium

2)No asthma features, initial treatment did not work: (LAMA + LABA)
LABA - salmeterol,
LAMA - tiotropium

2)Have asthmatic features,: (LABA + ICS)
LABA - salmeterol,
Inhaled corticosteroid

3)Still has daily symptoms after step 2 or has 1-2 exacerbations a year (LABA+LAMA+ICS)

Question 12

What complications of COPD?

Answer 12

Cor pulmonale - right sided heart failure due to respiratory disease (COPD) causing pulmonary hypertension.

Pulmonary hypertension

Question 13

What are the asthmatic features in determining COPD Mx?

Answer 13

• previous asthma or atopy
• raised eosinophil
• substantial variation in fev1 over time
• substance diurnal variation in peak expiratory volume