Management of COPD

Question 1

what is the aetiology of COPD?

Answer 1

environmental exposure to tobacco
Family clusters
AAT1 deficiency

Question 2

what are characteristics in the definition of COPD?

Answer 2

• progressive
• airflow obstruction
• not fully reversible
• doesn’t change much over months

Question 3

what conditions make up COPD?

Answer 3

chronic bronchitis
emphysema
airway obstruction

Question 4

why is COPD related to smoking?

Answer 4

Smoking causes increase macrophages –> increase proteases –> destruction of collagen and elastase –> damage to the alveolour wall –> emphysema

• paralysis of cilia
• mucous gland hyperplasia and hypersecretion –> chronic bronchitis

Question 5

what is seen in the pathology of chronic bronchitis?

Answer 5

increased goblet cells
gland hypertrophy
presence of mucous glands in smaller airways
bronchial wall inflammation
mucosal thickening

Question 6

what can be used to measure the extent of emphysema?

Answer 6

CT scans can show the dead space
pulmonary function tests will show increased residual vol
spiromtry

Question 7

why is there airway obstruction in emphysema?

Answer 7

There are less alveoli to hold the airway wall open causing bronchial collapse

Question 8

what spirometry results indicate obstructive disease?

Answer 8

• decreased FEV1 often 70% or more below predicted

ratio <0.7

Question 9

how can we measure if the changes seen in emphysema are reversible or not?

Answer 9

measure FEV1 pre and post bronchodilator. Able to reverse if there’s above a 15% improvement

Question 10

what are clinical signs of COPD?

Answer 10

wheeze, hyperinflation, pursed lip breathing, central cyanosis, flapping tremor, cor pulmonale, weight loss.

Question 11

how many pack years do you normally need to cause COPD?

Answer 11

20

Question 12

what investigations are done in COPD?

Answer 12

lung function, chest x ray, sputum, FBC,ABG, ECG

Question 13

what is involved in the long term management of COPD?

Answer 13

• vaccinations for influenza and pneumococcal
• inhalers: beta 2 agonist, anticholinergic, steroid
• theophyline
• diuretics
• LTOT
• mucolytics

Question 14

what bronchodilators are used in COPD?

Answer 14

Beta 2 receptor agonists

anti muscarinic

Question 15

what are the guidelines for on going breathlessness in COPD?

Answer 15

Start with a SABA/SAMA
if FEV1 is below 50% use a LABA and ICS or LAMA
if FEV1 is above half use just a LABA or a LAMA

Question 16

what are causes of COPD exacerbations?

Answer 16

infections mainly viral
air pollution
smoking

Question 17

how do you treat exacerbations in COPD?

Answer 17

broad spectrum antibiotics: penicillin, macrolide or tetracycline
oral prednisolone
nebulised bronchodilators
physio
low flow oxygen

Question 18

why are exacerbations in COPD importantant?

Answer 18

increased mortality

increases decline in lung function

Question 19

what can be done to prevent exacerbations in COPD?

Answer 19

• inhaled steroids
• vaccinations
• pulmonary rehab
• rescue pack antibiotics

Question 20

what are the advantages of giving oxygen to patients with COPD

Answer 20

• increased 5 year survival
• less polycythaemia
• improved pulmonary hypertension

Question 21

who do you give LTOT?

Answer 21

• partial oxygen below 7.3 on 2 occasions at least 3 weeks apart and clinically stable
• patient with partial oxygen between 7.3 and 8 but also have: PHT, polycythaemia, cor pumonale