COPD

Question 1

what is COPD

Answer 1

non-reversible, long term deterioration in airflow caused by damage to lung tissue

difficulty ventilarting lungs and prone to infectoin

Question 2

when to suspect COPD

Answer 2

long term smoker
SOB 
cough 
sputum production 
wheeze 
recurent resp infections

Question 3

MRC dyspnoea scale: Grade 1

Answer 3

breathless on strenuous exercise

Question 4

MRC dyspnoea scale: Grade 2

Answer 4

breathless walking uphill

Question 5

MRC dyspnoea scale: Grade 3

Answer 5

breathless on flat

Question 6

MRC dyspnoea scale: Grade 4

Answer 6

stop to catch breath after 100m on flat

Question 7

MRC dyspnoea scale: Grade 5

Answer 7

unable to leave house to due breathlessness

Question 8

diagnosing COPD

Answer 8

based on clinical picture + spirometry

Question 9

COPD spirometry

Answer 9

obstructive picture: FEV1/FVC <0.7

no dramatic response to reversibility testing

Question 10

severity of airflow obstruction: stage 1

Answer 10

FEV1 >80%

Question 11

severity of airflow obstruction: stage 2

Answer 11

FEV1 50-79%

Question 12

severity of airflow obstruction: stage 3

Answer 12

FEV1 30-49%

Question 13

severity of airflow obstruction: stage 4

Answer 13

FEV1 < 30%

Question 14

other Ix

Answer 14

CXR
FBC
BMI 
sputum culture 
ECG, ECHO 
CT

Question 15

long term Mx stepladder

Answer 15

1. SABA or short acting muscarinic
2. no steroid response: LABA + LAMA
   steroid response: LABA + ICS

Question 16

long-term Mx options for severe cases

Answer 16

neubulisers
theophyline 
oral muclytic therapy 
prophylacitc antib 
at home oxygen therapy

Question 17

when to use long-term O2 therapy

Answer 17

chronic hypoxia
polycythemia
cor pulmonale

Question 18

when not to use long term O2 therapy

Answer 18

if they smoke (fire hazard)

Question 19

COPD exacerbation

Answer 19

acute worsening of symptoms: cough, SOB, wheeze, sputum

usually triggered by viral or bacterial infection

Question 20

ABG: acidosis with raised PCO2

Answer 20

suggest they are acutely retaining

respiratory acidosis

Question 21

ABG: raised bicarbonate

Answer 21

indicates they chronically retain CO2 (kidneys produce more bicarb to balance acidic CO2)

in acute exacerbation kidneys can’t keep up and still become acidotic

Question 22

t1 resp failure

Answer 22

low pO2 and normal PCO2

Question 23

t2 resp failure

Answer 23

low PO2

raised pCO2

Question 24

oxygen therapy consideration in COPD

Answer 24

too much O2 in chronic retainer can depress resp drive - slow down RR and retain more CO2

Question 25

venturi masks

Answer 25

deliver specific percentage of oxygen

% can be carefully controlled

Question 26

If retaining CO2 aim for O2 sats of…

Answer 26

88-92% titrated by venturi mask

Question 27

if not retaining CO2 and normal bicarbonate (don’t chronically retain) aim for sats of…

Answer 27

> 94%

Question 28

medical treatment of exacerbation: at home

Answer 28

prednisolone 30mg OD
regular inhaler/neb
antibx if infection

Question 29

medical treatment of exacerbation: in hosp

Answer 29

nebulised bronchodilator
steroids
antib
physio

Question 30

medical treatment of exacerbation: severe. non responsive

Answer 30

IV aminophyline
NIV
intubate
doxapram

Question 31

what should patients with frequent exacerbations be offered

Answer 31

corticosteroids

antibiotics (advise only to be used if purulent sputum)