COPD

Question 1

what is COPD?

Answer 1

chronic disease state characterised by airway obstruction that is not fully reversible Encompasses both bronchitis and empysema

FEV1 <80% predicted
FEV1/FVC ratio <0.7

Question 2

what is bronchitis?

Answer 2

inflammation of the airways leading to thickening or scarring

production of sputum on most days for at least 3 months in last 2 years

Question 3

what is emphysema ?

Answer 3

abnormal enlargement of the airspaces distal to the terminal bronchioles

can be centri-acinar or pan-acinar

Question 4

what are the S&S of COPD?

Answer 4

smoking Hx and >35

SOB

Cough with sputum

Barrel chest (hyperinflation)

hyperresonance to percussion

decreased breath sounds

wheeze

decreased cricosternal distance (<3cm)

cyanosis

tachyapnoea

Asterixis

Question 5

what is the classifications of COPD based on spirometry?

Answer 5

Stage 1 (mild) = 80% predicated FEV1

Stage 2 (Mod) = 50-79% predicted FEV1

Stage 3 (severe) = 30-49% predicted FEV1

Stage 4 (v severe) = <30% predicted FEV1

Question 6

what are the InV for COPD?

Answer 6

Spirometry

• <80% prediced FEV1 and FEV1/FVC <0.7
• not reversible with salbutamol

CXR

ECG
- right atrial and ventricular hypertrophy

ABG
- T2RF

FBC
- increased PCV and haematocrit, anaemia

Pulmonary function test

• increased TLC and RV with decreased DLCO
• obstructive pattern

Question 7

what would a CXR of COPD show?

Answer 7

hyperinflation

Flat hemidiaphragms

Large central pulmonary arteries

decreased peripheral vascular markings

Bullae

Question 8

what is the GOLD classification of COPD severity?

Answer 8

Group A: low risk (0-1 exacerbation per year, not requiring hospitalisation) and fewer symptoms (mMRC 0-1 or CAT <10)

Group B: low risk (0-1 exacerbation per year, not requiring hospitalisation) and more symptoms (mMRC≥ 2 or CAT≥ 10)

Group C: high risk (≥2 exacerbations per year, or one or more requiring hospitalisation) and fewer symptoms (mMRC 0-1 or CAT <10)

Group D: high risk (≥2 exacerbations per year, or one or more requiring hospitalisation) and more symptoms (mMRC≥ 2 or CAT≥ 10)

Question 9

what are the treatment options for COPD?

Answer 9

smoking cessation

SABA - salbutamol inhaler
SAMA - ipratropium inhaler
- first choices in mild COPD

LABA - salmeterol
LAMA - tiotropium
Pulmonary rehab
- added in moderate COPD

LABA/ICS - fluticasone furoate/vilanterol inhaled or budesonide/formoterol inhaled
- added in ongoing symptoms and severe

mucolytics - carbocystiene or acetlycystiene
Chest physio
theophylline
Roflumilast
- added when ongoing symptoms or more severe

LTOT
- final option

Question 10

how does acute exacerbation of COPD present?

Answer 10

worsening of respiratory symptoms

- SOB, cough, sputum

Question 11

what are the common pathogens in infective exacerbation?

Answer 11

haemophilus influenzae
streptococcus pneumoniae
moraxiella catarrhalis

Question 12

how is acute exacerbation diagnosed and treated?

Answer 12

ABG, 02 sats, FBC, CXR, cultures

bronchodilator nebs 
oral prednisolone (IV hydrocortisone if unable) 
Abx - amoxicillin or doxy

Question 13

what are the complications of COPD?

Answer 13

pulmonary HTN 
lung CA 
PTX 
Depression 
RF