COPD

Question 1

What is COPD?

Answer 1

Chronic Obstructive Pulmonary Disease

reatable( but not curable) chronic condition that is characterised by persistent resp symptoms and air flow restriction

Question 2

What is the epidemiology of COPD?

Answer 2

• Data might underestimate
• 4th leading cause of death worldwide
• Prevalence 147 million worldwide, generally very common

Question 3

What is the Aetiology of COPD?

Answer 3

• Smoking –> increases irritation of the airway and triggers inflammatory response

Question 4

What are the risk factors for the development of COPD?

Answer 4

• Smoking
• Occupational exposure (dust fumes and chemicals)
• Air pollution (e.g. burning coal inside)
• Genetic
  
  • alpha1-antitrypsin deficiency.
• Asthma
• Congenital abnormal lung development

Question 5

How does choronic airway irritation lead to airway damage in COPD?

Answer 5

Leads to

• attraction of inflammatory cells that secrete damaging things (e.g. Elastase (Neutrophils), Metalloproteases + Oxidants (Macrophages)
  *

Question 6

Which parts of the airway are affected by COPD?

Answer 6

1. Chronic bronchitis
2. Small airway fibrosis (<2mm)
3. Emphysema in alveoli

Question 7

What does chronic Bronchitis in COPD lead to?

Answer 7

1. Overproduction of mucus
2. Goblet cell hyperplasia
3. Hypertrophy of submucosal gland

Question 8

What does Small airway fibrosis in COPD lead to?

Answer 8

• Small airwasy collapse
• Become obstructed and stonsed due to fibrosis

Question 9

What does emphysema in COPD lead to?

Answer 9

• Break down of elastiv tissue port of alveoli
• Increased air space, decreased tissue leading to decrease in gas exchanging surface area

Question 10

What are the presenting symptoms of COPD?

Answer 10

• Chronic productive cought with clear or white sputum
  
  • due to chronic bronchitis >3/12 for >2years
• Exertional SOB progressively worse
• Frequent Lower resp. tract infection
• Weight loss, anorexia, fatigue
• Due to hypoxia and increased effort to breath
• Chest tightness, wheezing

Question 11

What are signs of COPD on examination?

Answer 11

• Cyanosis
• Hyperinflation
  
  • Barrel chest
  • Hyperresonance
  • Decreased crico-sternal distance and expansion
  • Quiet breath sounds
• Wheezing and basal crackels on auscultation
• Raised JVP (cor pulmonale)
• Pursed lip expiration
• Kachexia
• Ankle oedema
• Normally no haemoptysis and chest pain

Question 12

What are the investigations you would do in a Patient with suspected COPD ?

Answer 12

• Spirometry
• CXR
• FBC (exclude anaemia of chronic disease)
• Heart
  
  • BNP and ECG if suspected cor pulmonale
• Consider alpha-1 antitrypsin deficiency screening if COPD, young, no risk factors

Question 13

What are the findings of Spirometry you would expect in a patient with COPD?

Answer 13

• Post-bronchodilator spirometry with FEV1/FVC <0.7
• reduced FEV and FEV1 with decreased FEV1/FEC ratio
• FEV1/FVC ration is used to determine GOLD stadium

Question 14

What is a typical ECG of a pateint with Cor Pulmonale?

Answer 14

• Left shift
• right atrial and ventricular hypertrophy

Question 15

Which findings would you expect on a CXR from a COPD patient?

Answer 15

• Hperinflation
• Flat hemidiaphragms, Large ventral pulmonary, arteries, decreased peripheral vascular markings, Bullar

Question 16

What are possible complications of a patient with COPD?

Answer 16

• Reduced quality of life
  
  • Acute exacerbations
• Cor pulmonale
• Frequent chest infection and ? Hospital admission
• Secondary Polycythaemia
• Resp failure
• Pneumothorax (if empyhsema ruptures)

Question 17

What is the conservative management for COPD patients?

Answer 17

• Smoking cessation
• Pulmonary rehabilitation (tendency about more severe cases)
• Vaccination
  
  • Influenza
  • Pneumococcal
• Physiotherapy and Occupational Therapy
• Dietetic advise
• Psychology (if co-exiting mental health problems)

Question 18

What is the medical management of Patients with COPD?

Answer 18

• Oxygen (if sats <88%, aim for 92%)
• SABA or SAMA (Short acting muscarinic antagonist
• If not work: LABA and LAMA
• If still no improvement: LABA + LAMA + ICS
• Long-term ABX to decrease risk of infection

Question 19

When would you consider specialist referral for a Patient with COPD?

Answer 19

• Diagnostic uncertainty
• Severe COPD (<30% FEV1)
• >2 exacerbationn in one year
• Significant sputum burden
• Age <40 a1antit-deficienc<
• Sats <92%
• Weight loss of haemoptysis via 2 WW referal

Question 20

What is the prognosis of a patient with COPD?

Answer 20

• Generally gradual decline with progressive loss of lung function
• Generally worse with

Question 21

What are worse prognostic factors in COPD patients?

Answer 21

• Low FEV1
• Smoking
• Severer symptoms and burden
• Muscle wasting and low weight
• Increased hospital admission due to exacerbation
• Multimorbidity and frailty

Question 22

What are the effects of LAMAs in COPD?

Answer 22

= Long acting muscarenic antagonis

• decreased mucus production
• airway dilation (decreased Smooth Airway muscle constriction)