COPD

Question 1

Features of COPD?

Answer 1

Decreased exercise tolerance

Productive cough on background of smoking history

Question 2

What is COPD and what 2 diseases is it consistent of?

Answer 2

Chronic progressive disorder characterised by airflow obstruction
- encompasses chronic bronchitis + emphysema

Question 3

What is chronic bronchitis?

Answer 3

Defined as

- “cough with sputum for most days of a 3 month period on 2 consecutive years”

Question 4

What is emphysema?

Answer 4

Pathological permanent destructive enlargement of the alveoli

Question 5

What is the main risk factor for COPD?

Answer 5

Smoking

Question 6

2 biological processes that occur in COPD?

Answer 6

Hypertrophy of goblet cells (extra mucus)
Decreased cilia (reduced ability to clear mucus hence the cough)
Loss of alveoli elastic recoil (decline in spirometry measures)

Question 7

What does the persistent hypoxia seen in COPD cause?

Answer 7

Pulmonary vascular hypertension

- this leads to cor pulmonale

Question 8

What is cor pulmonale?

Answer 8

Abnormal enlargement of the right side of the heart as a result of disease of the lungs or pulmonary blood vessels (pulmonary vascular hypertension in COPD for example)

Question 9

Features of COPD in patient? (symptoms + signs)

Answer 9

Symptoms

• productive cough worse in the mornings
• exertional dyspnoea
• recurrent chest infections

Signs

• expiratory wheeze
• bibasal crepitations
• also heard of “fine crackles throughout the whole lung field”

Question 10

What signs might be seen on examination of a COPD patient?

Answer 10

Central cyanosis
CO2 retention 
Right heart failure
Pursed lips
Barrel chest
Intercostal in-drawing
Tracheal tug

Question 11

Signs of CO2 retention?

Answer 11

Flapping tremor
Bounding pulse
Warm peripheries

Question 12

How is COPD diagnosed?

Answer 12

FEV1 <80%
FEV1:FVC ratio <70%
- Lung capacity increased
- Residual volume increased

Question 13

ABG findings in COPD?

Answer 13

Hypoxia + hypercapnia (commonly chronic CO2 retention with complete metabolic compensation)

• normal pH
• high pCO2
• high HCO3-

Question 14

CXR findings in COPD?

Answer 14

Hyper-translucent lung fields
Flat diaphragm
Prominent hila
Bullae

Question 15

Management of chronic mild/moderate COPD?

Answer 15

Smoking cessation
Antibiotics for infections
Regular anticholinergics (ipratropium)
Salbutamol inhaler as required

Question 16

What is given in severe COPD and what are the thresholds for indication?

Answer 16

Long-term oxygen therapy (LTOT) 1-4L/min via nasal cannulae

• given up smoking
• pO2 <7.3
• FEV1 <1.5L

Question 17

What drug can be given to aid smoking cessation and when is it given?

Answer 17

Bupropion - given 2 weeks before stopping

Question 18

Diagnosis criteria for acute exacerbation of COPD?

Answer 18

• Worsening exercise tolerance
• Increasing sputum volume
• Increasing sputum purulence

Question 19

Management of acute exacerbations of COPD?

Answer 19

• 24-28% oxygen
• nebulised salbutamol
• oral prednisolone
• prophylactic LMWH
  consider ventilator support if CO2 is rising/patient is acidotic despite adequate oxygen therapy