COPD

Question 1

Define COPD

Answer 1

Chronic progressive disorder characterised by airway obstruction with little or no reversibility, including chronic bronchitis and emphysema.

Question 2

What are key features of COPD that help to distinguish from asthma?

Answer 2

• Age of onset >35
  
  • Smoking or pollution history
  • Chronic SOB
  • Sputum production
  • Minimal diurnal variation

Question 3

What is chronic bronchitis?

Answer 3

a cough with sputum production on most days for 3 months on 2 successive years. Symptoms tend to improve with smoking cessation.

Question 4

What is emphysema?

Answer 4

histologically defined as enlarged air spaces distal to the terminal bronchioles, with destruction of alveoli.

Question 5

What are symptoms of COPD?

Answer 5

• Cough
  
  • Sputum
  • SOB
  • Wheeze

Question 6

What are signs of COPD?

Answer 6

• Tachypnoea 
	• Accessory muscles use
	• Hyperinflation 
	• Decreased chest expansion
	• Resonant or hyper-resonant percussion note 
	• Quiet breath sounds 
	• Wheeze
	• Cyanosis 
Cor pulmonale

Question 7

What investigations for COPD?

Answer 7

Bloods: polycythaemia, infection if IECOPD

CXR: hyperinflation

ECG: cor pulmonale e.g. RVH

ABG: resp failure

Spirometry: increased TLC, increased residual volume, decreased DLCO, decreased FEV1 and FEV1/FVC ratio (diagnostic!)

Alpha 1 anti-trypsin: young age, family history, no smoking

Peak flow

Question 8

How is COPD staged?

Answer 8

By FEV1% predicted.

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

Question 9

How is COPD treated?

Answer 9

Smoking cessation is important to prevent FEV1% decreasing

1. SABA or SAMA
2. Add LABA, LAMA, or LABA w ICS
3. LABA + ICS or LAMA, LABA and ICS

LTOT: if non-smoker and PaO2 7.3 (or 8 with pulmonary hypertension, polycythaemia, oedema, hypertension, noctural hypoxia)

NIV if hypercapnic on LTOT

Azithromycin prophylaxis in non-smokers to prevent infections

Question 10

What investigations for suspected IECOPD?

Answer 10

• ABG
  
  • CXR
  • Bloods
  • ECG
  • Sputum cultures and blood cultures if pyrexial

Question 11

What is management of IECOPD?

Answer 11

Nebulised bronchodilators (SABA and IB)
Oxygen
Steroids
Antibiotics

if not responding,
IV aminophylline
NIV if RR >30, pH <7.35 or PaCO2 rising

ICU

Question 12

What are the indications for LTOT?

Answer 12

For non-smokers only

PaO2 <7.3kPa despite maximal treatment OR <8.0kPa with pulmonary hypertension, oedema, nocturnal hypoxia, or polycythaemia

Question 13

What infection prophylaxis should be given to people with COPD?

Answer 13

Azithromycin in people with frequency exacerbations in spite of optimised treatment
Non smokers only

Question 14

What are complications of COPD?

Answer 14

IECOPD, pneumonia, cor pulmonale, pneumothorax

Question 15

What organisms commonly cause IECOPD?

Answer 15

HI
Strep pneum
Moraxella catarrhalis