COPD

Question 1

COPD definition

Answer 1

1. Airway obstruction: FEV1 <80%, FEV1:FVC <0.70
2. Chronic bronchitis: cough and sputum production on
   most days for 3 months of 2 successive years.
3. Emphysema: histological diagnosis of enlarged air
   spaces distal to terminal bronchioles.

Question 2

Causes of COPD

Answer 2

Smoking
Pollution
alpha1 antitrypsin deficiency

Question 3

Signs of COPD

Answer 3

Tachypnoea
Prolonged expiratory phase
Hyperinflation
↓Cricosternal distance (normal = 3 fingers)  Loss of cardiac dullness
Displaced liver edge
Wheeze
May have early-inspiratory crackles
Cyanosis
Cor pulmonale: ↑JVP , oedema
Signs of steroid use

Question 4

Respiratory failure in COPD

Answer 4

Pink Puffers - emPhysema - type 1 respiratory failure

Blue bloaters - Chronic Bronchitis - type 2 resp failure

Question 5

mMRC dyspnoea score

Answer 5

1. Dyspnoea only on vigorous exertion
2. SOB on hurrying or walking up stairs
3. Walks slowly or has to stop for breath
4. Stops for breath after <100m / few min
5. Too breathless to leave house or SOB on dressing

Question 6

Complications of COPD

Answer 6

Acute exacerbations ± infection
Polycythaemia
Pneumothorax (ruptured bullae)
Cor Pulmonale
Lung carcinoma

Question 7

Investigations for COPD

Answer 7

1. BMI
2. Bloods: FBC (polycythaemia), α1-AT level, ABG
3. CXR - Hyperinflation (> 6 ribs anteriorly), Prominent pulmonary arteries, Peripheral oligaemia, Bullae
4. ECG: R atrial/ventricular hypertrophy
5. Spirometry: FEV1 <80%, FEV1:FVC <0.70, ↑TLC, ↑RV  6. Echocardiogram

Question 8

Severity of COPD

Answer 8

Mild: FEV1 >80% (but FEV/FVC <0.7 and symptomatic)
Mod: FEV1 50-79%
Severe: FEV1 30-49%
Very Severe: FEV1 < 30%

Question 9

Treatment of COPD

Answer 9

Stop smoking
Mucolytics: carbocisteine

1) Breathlessness and/or exercise limitation
SABA and/or SAMA (ipratropium) PRN

2) Exacerbations or persistent breathlessness
- FEV1 ≥50%: LABA or LAMA (tiotropium) (stop SAMA)
- FEV1 <50%: LABA+Inhaled corticosteroid(ICS) combo or LAMA

3) Persistent exacerbations or breathlessness
- LABA+LAMA+ICS
- Roflumilast / theophylline (PDIs) may be considered
- Consider home nebs

4) Long term O2 therapy
Aim: PaO2 ≥8 for ≥15h / day (↑ survival by 50%)

Question 10

Surgery for COPD

Answer 10

Recurrent pneumothoraces
Isolated bullous disease
Lung volume reduction

Question 11

Causes of acute exacerbation of COPD

Answer 11

Viral URTI (30%)
Bacterial

Question 12

Investigations of acute exacrbation

Answer 12

PEFR
Bloods: FBC, U+E, ABG, CRP , cultures
Sputum culture
CXR: infection, pneumothorax
ECG

Question 13

Differentials of acute exacerbation

Answer 13

Pneumothorax
Pulmonary oedema
PE
Asthma

Question 14

Treatment of acute exacerbation

Answer 14

1. Controlled O2 therapy: SpO2-88-92%
2. Nebulised bronchodilators: salbutamol or ipratropium
3. Steroids: hydrocortisone IV and prednisolone PO
4. Abx if sign of infection doxycycline
5. Non invasive ventilation if no response