COPD

Question 1

What is COPD?

Answer 1

chronic inflammation of the lungs which leads to obstruction of the airways with little to no reversibility

Question 2

What are the different severities of COPD?

Answer 2

Mild: FEV1 >80%

Moderate: FEV1 50-79%

Severe: FEV1 30-49%

Very Severe: FEV1 <30%

Question 3

What is the cause of COPD?

Answer 3

Tobacco smoking or irritants cause the bronchial and alveoli lose their elasticity and over-expand leading to trapped air in the lungs upon exhalation

Question 4

What is Chronic Asthma?

Answer 4

Chronic Inflammatory disorder of the airway causing episodic exacerbations of reversible bronchoconstriction characterised by wheezing, chest tightness and coughing

Question 5

What is Chronic Bronchitis?

Answer 5

Inflammation of lining of the bronchial tubes, characterised by daily cough and sputum production for 3months of 2 successive years

Question 6

What is Emphysema?

Answer 6

Destruction of the alveoli walls due to irritants leading to an umpired airflow out of the lungs

Question 7

What are the symptoms of COPD?

Answer 7

Cough

Sputum

Dyspnoea on exertion

Wheezing on expiration

Chest tightness

Question 8

What are the signs of COPD?

Answer 8

Tachypnoea

Hyperinflation (barrel chest)

Decreased cruciate rank distance (<3cm)

Decreased expansion

Resonant or hyper-resonant percussion note

Quiet breath sound

Central cyanosis

Question 9

What are the risk factors of COPD?

Answer 9

Age (over 35)

genetics - Alpha1 antitrypsin Deficiency

Asthma

Exposure to irritants

Question 10

What are the top differentials of COOD?

Answer 10

GORD

ASTHMA

CONGESTIVE HEART FAILURE

ACEI INDUCED CHRONIC COUGH

Question 11

Which blood test would you do for COPD?

Answer 11

FBC: high haematocrit

ABG: low PaO2, high PaCO2

Question 12

What would the lung function test show for COPD?

Answer 12

FEV1 <80% of predicted

FEV1/FEV ratio <70%

high TLC and RV

Question 13

Which imaging would you do for COPD?

Answer 13

CXR: Hyperinflation, flat hemidiaphragms; Bullae

CT: bronchial wall thickening and scarring

Question 14

What would an ECG show for COOD?

Answer 14

Right atrial and ventricular hypertrophy (Cor Pulmonale)

Question 15

What is the management route of COPD and Chronic Asthma?

Answer 15

SABA or SAMA >

FEV1 >50% > LABA or LAMA > LABA+ICS or LAMA + LABA/ICS combination inhaler

FEV1 <50% > LABA + ICS in combined inhaler or LAMA > LAMA + LABA/ICS combination inhaler

Question 16

How do Beta Agonist work? What are their side effect?

Answer 16

Bronchodilators that bind to beta adrenergic receptors to open calcium channels and relax smooth muscles

SIDE EFFECTS: tachycardia, myocardial ischaemia, tremor, hypokalaemia

Question 17

What is an example of an SABA and an LABA? What are difference between the two?

Answer 17

SABA: Salbutamol

LABA: Salmeterol

DIFFERENCE:

SABA = acute treatment of bronchospasm

LABA = chronic treatment of bronchospasm

Question 18

How do Muscarinic Antagonist work? What are the side effects?

Answer 18

Bronchodilators that bind to muscarinic receptors and block acetylcholine and cause the smooth muscles to relax

SIDE EFFECTS:
Dry mouth, nausea, headache

Question 19

What is an example of SAMA and an LAMA?

Answer 19

SAMA: Ipratropium

LAMA: Tiotropium

Question 20

How do Xanthines work?

Answer 20

Bronchodilators that inhibit phosphodiasterase from breaking down cAMP which leads to bronchodilation and binds to A2B receptors to prevent bronchoconstriction

SIDE EFFECTS:
tachycardia, convulsions, hypokalaemia

Question 21

What is an example of a Xanthine used to treat COPD?

Answer 21

Oral Theophylline

Question 22

Name an example of an inhaled corticosteroids?

Answer 22

Budesonide or Fluticasone

Question 23

What is in seritide and Symbicort?

Answer 23

Seritide = Salmeterol + Fluticasone

Symbicort = Formoterol + Budesonide

These are combined inhalers

Question 24

What is Long-term Oxygen Therapy? When is it used?

Answer 24

Supplement of oxygen to treated to achieve SaO2 >90% to minimise pulmonary hypertension

It is used in stable patients who have PaO2 <7.3kPa