FN: COPD

Question 1

Definition

Answer 1

Airway obstruction
Chronic bronchitis
Emphysema

Question 2

Airway obstruction

Answer 2

FEV1 <0.70

Question 3

Chronic bronchitis

Answer 3

cough and sputum production on most days for 3 months of 2 successive years

Question 4

Emphysema:

Answer 4

histological diagnosis of enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls.

Question 5

Causes

Answer 5

• Smoking
• Pollution
• Alpha1ATD – young age COPD + FH

Question 6

Symptoms

Answer 6

• Cough + sputum
• Dyspnoea
• Wheeze
• Wt. loss

Question 7

Signs

Answer 7

•	Tachypnoea
•	Prolonged expiratory phase
•	Hyperinflation
→ Reduced cricosternal distance
→ Loss of cardiac dullness
→ Displaced liver edge
•	Wheeze
•	May have early-inspiratory crackles
•	Cyanosis
•	Cor pulmonale: raised JVP, oedema, loud P2
•	Signs of steroid use

Question 8

Pink Puffers

Answer 8

Emphysema
•	Raised alveolar ventilation → breathless but no cyanosed
•	Normal or near normal PaO2
•	Normal of low PaCO2
•	Progress → T1 respiratory failure

Question 9

Blue Bloaters

Answer 9

Chronic Bronchitis
• Reduced alveolar ventilation → cyanosed but not breathlessness
• Reduced PaO2 and raised PaCO2: rely on hypoxic drive
• Progress → T2 respiratory failure and cor pulmonale

Question 10

Complications

Answer 10

Acute exacerbations ±infection
Polycythaemia
Pneumothorax (reuptured bullae)
Cor pulmonale
Lung carcinoma

Question 11

Treatments →

Answer 11

General

Mucolytic:

Breathlessness and/or exercise limitation

Exacerbations or persistent breathlessness

Persistent exacerbations or breathlessness
LTOT (long term oxygen therapy)
Surgery

Question 12

General

Answer 12

1. Stop smoking
   a. Specialist nurse
   b. Nicotine replacement therapy
   c. Bupoprion, varenicline (partial nicotineagonist)
   d. Support programme
2. Pulmonary rehab
3. Treat poor nutrition and obesity
4. Manage comorbidities e.g. cardiovasc, lung cancer, osteoporosis
5. Influenza and pneumococcal vaccine

Question 13

Mucolytic:

Answer 13

Carbocisteine

Question 14

Breathlessness and/or exercise limitation

Answer 14

• SABA and/or SAMA (ipratropium) PRN

* SABA PRN may continue at all stages

Question 15

Exacerbations or persistent breathlessness

Answer 15

• FEV >50% LABA or LAMA (tiptropium)

* FEV1<50% LABA + ICS combo or LAMA

Question 16

Persistent exacerbations or breathlessness

Answer 16


o (PDIs) may be considered
Consider home nebs

Question 17

LTOT (long term oxygen therapy)

Answer 17

PaO2 >8 for >15h/day (increased survival by 50%)

Question 18

Surgery

Answer 18

Recurrent penumothoraces
Isolated bullous disease
Lung volume reduction

Question 19

Bloods show

Answer 19

• FBC (polycythaemia)
• Alpha1-AT level
• ABG

Question 20

CXR

Answer 20

• Hyperinflation (>6 ribs anteriorly)
• Prominent pulmonary arteries
• Peripheral oligaemia
• Bullae

Question 21

ECG

Answer 21

• R atrial hypertrophy: P Pulmonale

* RVH, RAD

Question 22

Spirometry

Answer 22

• FEV1 <0.70
• Raised TLC
• Raised RV

Question 23

Echo

Answer 23

• PHT