COPD

Question 1

what is COPD?

Answer 1

• preventable and treatable disease characterised persistent, progressive airflow limitation (not fully reversible)
• enhanced chronic inflammatory response in the lungs to noxious gases/particles

Question 2

what happens with large airways inflammation?

Answer 2

airways narrowing due to chronic irritation of the bronchi causing inflammation and changes to the mucociliary escalator often results in a chronic cough

Question 3

what happens with the small airways?

Answer 3

airways narrowing due to bronchoconstriction and inflammation; duration and severity are risk factors for development or airway remodelling and COPD

Question 4

what happens with emphysema?

Answer 4

airways collapse due to destruction of alveolar walls - may lead to bullae

Question 5

what happens to the airways with COPD?

Answer 5

• chronic inflammation
• increased number of goblet cells
• mucus hyperplasia
• fibrosis
• narrowing and reduction in the number of small airways
• airway collapse due to alveolar wall destruction in emphysema

Question 6

what are the symptoms for chronic bronchitis (large airways)?

Answer 6

• chronic productive cough for 3 months in 2 successive years
• exclude other causes of chronic cough

Question 7

what are the symptoms of emphysema (alveolar)?

Answer 7

• abnormal and permanent enlargement of the airspace due to destruction of the alveolar airspace walls
• effects gas exchange

Question 8

what are the symptoms of small airways disease?

Answer 8

wheeze

Question 9

what are the risk factors of COPD?

Answer 9

• cigarette smoke
• occupational dust and chemicals
• environmental tobacco smoke (ETS)
• indoor and outdoor air pollution
• genes
• infections
• socio-economic status
• ageing population

Question 10

what smoking history do you need to take?

Answer 10

• age started
• calculate pack-year history
• times stopped and why failed quit attempt
• recreational drugs smoked (or other substances)

Question 11

how do you diagnose COPD?

Answer 11

symptoms + risk factors + spirometry

Question 12

what is the impact of grade 1 COPD?

Answer 12

not troubled by breathlessness except on vigorous exertion

Question 13

what is the impact of grade 2 COPD?

Answer 13

short of breath when hurrying or walking up inclines

Question 14

what is the impact of grade 3 COPD?

Answer 14

walks slower than contemporaries because of breathlessness or has to stop for breath when walking at own pace

Question 15

what is the impact of grade 4 COPD?

Answer 15

stops for breath after walking about 100m or stops after a few minutes walking on the level

Question 16

what is the impact of grade 5 COPD?

Answer 16

too breathless to leave the house or breathless on dressing or undressing

Question 17

what are the physical signs of COPD?

Answer 17

• barrel shaped chest
• hyperresonant percussion
• accessory muscles
• prolonged expiration
• pursed-lip breathing
• tripod position
• low BMI
• nicotine staining

Question 18

what are the physiological effects of COPD?

Answer 18

• increased work of breathing
• reduced exercise tolerance
• impaired gas exchange: hypoxia, hypercapnia, raised pulmonary artery pressure, RV dilatation, cor pulmonale
• loss of fat-free mass

Question 19

how do you manage chronic COPD?

Answer 19

• stop smoking
• if symptomatic LABA/LAMA combined inhaler
• lots of inhalers
• flu vaccination
• educate and empower
• treat exacerbations
• pulmonary rehabilitation
• think about the whole patient (bones, nutrition, mental health)
• LTOT

Question 20

what happens with pulmonary rehabilitation?

Answer 20

• 2x supervised sessions for 6 weeks
• supervised exercise
• education
• psychosocial support/group work

Question 21

what are the other possible treatments for COPD?

Answer 21

• theophylline (oral phosphodiesterase inhibitor)
• azithromycin 3x a week (anti-inflammatory antibiotic prophylaxi)
• lung volume reduction surgery
• lung transplantation

Question 22

what is acute exacerbation?

Answer 22

acute deterioration in symptoms requiring additional therapy

• mild (SABA)
• moderate (SABA +/- steroids +/- antibiotics)
• severe (hospital admission) or ED attendance

Question 23

what happens with severe exacerbation of COPD?

Answer 23

ED attendance due to progressive dyspnoea/hypoxia or signs of infection or signs of right heart failure

• antibiotics in signs of infection
• oral steroids
• target saturation 88-92%
• nebulisers
• consider diruetics
• nicotine replacement therapy/refer for smoking cessation

Question 24

why do you use non-invasive ventilation for COPD?

Answer 24

decompensated hypercapnic respiratory failure despite controlled oxygen and nebuliser treatments

Question 25

why do you consider invasive mechanical ventilation for COPD?

Answer 25

respiratory failure despite nebulised therapy and controlled oxygen and patient unable to tolerate NIV

Question 26

when do you palliate for COPD?

Answer 26

respiratory ventilation on background of significant progressive decline over several months/years with no evidence of reversible event

Question 27

how do you control the symptoms of COPD?

Answer 27

• oromorph
• lorazepam
• fan therapy
• oxygen therapy
• CBT
• pacing/breathing strategies
• hospice input