COPD

Question 1

Discuss GOLD criteria for COPD

Answer 1

GOLD guidelines support using the traditional bronchodilator FEV1/FVC ratio less tahn 0.7 as the threshold for airflow limitation.

GOLD ABCD grading
A) 0 to 1 exacerbation without hospitalization + mMRC 0-1
B) 0 to 1 exacerbation without hospitalization + mMRC >2
C) >2 exacerbation or >1 hospitalization + mMRC 0-1
D)>2 exacerbation or >1 hospitalization + + mMRC >2

GOLD severity of airflow limitations (FEV1 predicted)

• GOLD 1 -mild >80
• GOLD 2 - moderate 50-79’
• GOLD 3 - severe 30-49
• GOLD 4 - very severe <30

Question 2

Discuss CXR in COPD

Answer 2

Can determine if there is an acute treatable cause for clinical deterioration, especially pneumothorax or parenchymal consolidation

Finding of COPD include

• hyperinflated lung fields
• decreased vascular markings
• small cardiac silhouette
• Bullae

Question 3

Discuss indication and contraindications for NIV in COPD

Answer 3

Indications

• Moderate to severe dyspnoea with use of accessory muscles and paradoxical abdominal motion
• RR >25
• Moderate to severe acidosis (ph <7.35) and hypercapniea (>45)

Exclusion

• Respiratory arrest
• CVS instability
• uncooperative patients (agitated or severely somnolent)
• Upper airway obstruction
• High aspiration risk
• Recent facial or gastro surgery
• Craniofacial trauma, fixed nasopharyngeal abnromalities
• non fitting mask