COPD

Question 1

Define COPD

Answer 1

Chronic, progressive lung disorder characterised by airflow obstruction with:
Chronic bronchitis: continuous cough + sputum production for >, 3 months over 2 years
Emphysema: pathological destruction of air spaces in terminal bronchioles

Question 2

What is bronchial and alveolar damage caused by?

Answer 2

Environmental toxins e.g. cigarette smoke

Question 3

What is a rare cause of COPD? When should this be considered?

Answer 3

Alpha 1 antitrypsin deficiency

In young patients / people who have never smoked.

Question 4

Give 4 characteristics of chronic bronchitis

Answer 4

Narrowing of the airways resulting in bronchiole inflammation (bronchiolitis)
Bronchial mucosal oedema
Mucous hypersecretion
Squamous metaplasia

Question 5

What characterises emphysema?

Answer 5

Destruction + enlargement of alveoli
Loss of elasticity that keeps small airways open in expiration
Progressively larger spaces develop called bullae (diameter > 1 cm)

Question 6

Summarise the epidemiology of COPD

Answer 6

8% prevalence
Presents in middle age or later
M > F: may change due to rise in female smokers

Question 7

List 5 symptoms of COPD

Answer 7

Chronic cough  
Sputum production  
Breathlessness  
Wheeze  
Reduced exercise tolerance

Question 8

List 5 signs found on inspection of a patient with COPD

Answer 8

Respiratory distress 
Use of accessory muscles  
Barrel-shaped over-inflated chest  
Decreased cricosternal distance  
Cyanosis

Question 9

List 2 signs found on percussion of a patient with COPD

Answer 9

Hyper-resonant chest

Loss of liver + cardiac dullness

Question 10

List 5 signs found on auscultation of a patient with COPD

Answer 10

Quiet breath sounds  
Prolonged expiration  
Wheeze 
Rhonchi - rattling, continuous + low-pitched breath sounds (likened to snoring, due to secretions in larger airways or obstruction)
Sometimes crepitations

Question 11

What are the signs of CO2 retention? What signs may present in late stages?

Answer 11

CO2 retention flap
Bounding pulse  
Warm peripheries  
LATE STAGES: signs of right heart failure- 
RV heave  
Raised JVP 
Ankle oedema

Question 12

What would be found on spirometry testing and pulmonary function testing of a patient with COPD?

Answer 12

Reduced PEFR
Reduced FEV1/FVC
Increased lung volumes
Decreased carbon monoxide gas transfer coefficient

Question 13

Describe CXR findings of a patient with COPD

Answer 13

May appear NORMAL
Hyperinflation (> 6 anterior ribs in MCL at diaphragm level, flattened diaphragm)
Reduced peripheral lung markings
Elongated cardiac silhouette

Question 14

What blood test is needed in COPD and why?

Answer 14

FBC: increased Hb + haematocrit due to secondary polycythaemia

Question 15

What may be seen on an ABG of a patient with COPD?

Answer 15

Hypoxia

Normal/ raised PCO2

Question 16

Why perform an ECG and echocardiogram on a COPD patient?

Answer 16

To check for cor pulmonale

COPD can cause pulmonary HTN

Question 17

When are blood and sputum cultures useful in COPD?

Answer 17

Acute infective exacerbations

Question 18

What would you measure in a young patient who had never smoked if you suspected COPD?

Answer 18

Alpha 1 antitrypsin levels

Question 19

List 3 bronchodilators that can be used in the management of COPD

Answer 19

SABAs (e.g. salbutamol)
Anticholinergics (e.g. ipratropium bromide)
LA beta-2 agonists (if > 2 exacerbations per year)

Question 20

Describe steroid usage in the management of COPD

Answer 20

Inhaled beclamethasone: considered in all patients with FEV1 < 50% of predicted OR > 2 exacerbations per year
Regular oral steroids avoided if possible

Question 21

List 3 other management strategies used for COPD

Answer 21

Prevent infective exacerbations: pneumococcal + influenza vaccination
Pulmonary rehabilitation
Oxygen Therapy: used if PO2 <7.3 during clinical stability

Question 22

What advice is often given to a patient with COPD?

Answer 22

STOP SMOKING

Question 23

List 6 possible complications of COPD

Answer 23

Acute respiratory failure  
Infections  
Pulmonary HTN
Right heart failure  
Pneumothorax (secondary to bullae rupture)  
Secondary polycythaemia

Question 24

Summarise the prognosis of a patient with COPD

Answer 24

High morbidity

3y survival rate ~ 90-75% depending on FEV1:FVC.