COPD

Question 1

Typical clinical features of COPD?

Answer 1

• chronic cough with sputum production
• dyspnoea & tachypnoea (early on exertion, advanced all the time)
• pursed lip breathing (emphysema)
• cyanosis (bronchitis)
• end-expiratory wheeze

Question 2

Tell me about the blue bloater sub-species of COPD?

Answer 2

Blue bloater = chronic bronchitis

• productive cough
• overweight
• smoker
• peripheral oedema
• PaO2 - v low
• PaCO2 - high

RETAINERS

Question 3

Tell me about pink puffers?

Answer 3

pink puffer = emphysema

• pursed lip breathing
• cachectic
• mild cough
• noncyanotic
• PaO2 - low
• PaCO2 - normal (reduced late)

Question 4

A patient has all the signs of COPD but he is also hypoalbuminic and jaundiced. What is the diagnosis?

Answer 4

Alpha 1 antitrypsin deficiency

Question 5

What is the diagnostic spirometry test for COPD? and results considered to be a positive diagnosis?

Answer 5

post bronchodilator FEV1 to FVC ratio

<0.7 is diagnostic

Question 6

How can you grade severity of COPD based on a patients FEV1?

Answer 6

stage 1-4 
1 = 80% predicted or higher 
2 = 50-80%
3  = 30-50%
4 = <30% or <50% w/ resp failure

Question 7

What is the breathlessness scale called? Tell me summert about it.

Answer 7

MRC dyspnoea scale
1-5
progressive worsening breathlessness when doing smaller tasks
1 = not troubled by breathlessness when doing strenuous exercise
5= can’t leave the house due to breathlessness and gets breathless getting dressed

Question 8

Symptoms of an acute exacerbation of COPD?

Answer 8

CARDINAL FEATURES

• increased breathlessness or coughing
• increased sputum production and/or colour change

EXTRAS

• chest tightness
• wheeze
• systemic features of infection
• increased peripheral oedema

Question 9

What are the common causes of an exacerbation of COPD?

Answer 9

• rhinovirous
• smoking
• environmental factors
• haemophilus influenza/strep penumoniae

Question 10

What would you treatment of an exacerbation of COPD in the community?

Answer 10

• 5 days oral pred
• amoxicillin if indicated 5 days
• send sputum cultures if not responded in 3 days
• admit dependent on severity

Question 11

How do you treat a stable COPD?

Answer 11

• smoking cessation
• pneumococcal vaccine
• self management plan

Cascade

• SABA or SAMA
• LABA + LAMA (plus ICS if asthmatic features or 3/12 trial to see if helpful w/o asthmatic features)
• refer

Question 12

Who can be offered prophylactic Abx? What needs to be done before initiating tx? what is the abx lol?

Answer 12

• 3 exacerbations w/in 1 year requiring steroids
• optimised medical Tx
• NOT smoking

before starting

• ECG (long QTc) - 1/12 later
• LFT baseline - 1/12 later then 6/12ly
• counsel of SEs - if present reduce dose 1/2

Azathioprine - 500mg 3 times per week

Question 13

What assessment needs to be made for a COPD patient that might require LTOT?

Answer 13

• 2 ABGs 3 weeks apart - PaO2 <7.3
• must not smoke
• most be assessed for tripping risk