Chronic Obstructive Pulmonary Disease (COPD)

Question 1

What is COPD?

Answer 1

A chronic slowly progressive lung disorder characterised by airflow obstruction. Patient usually has chronic bronchitis and emphysema as well.

Question 2

What is Chronic bronchitis?

Answer 2

Chronic cough and sputum production on most days for atleast 3 months per year, for two consecutive years.

Question 3

What is emphysema?

Answer 3

Pathological Diagnosis of permanent destruction, enlargement of air spaces distal to the terminal bronchioles.

Question 4

What are the causes of COPD?

Answer 4

• Bronical and alveolar damage as a results of environmental toxins (smoking)
• Rarely Alpha 1 Antitrypsin deficiency (<1%) – Consider in young patients who never smoke
• Risks Factors: – Smoking, Recurrent Bronchopulmonary infection, Occupational
Exposure (mining / cotton).

Question 5

What’s the epidemiology of COPD?

Answer 5

– Very common – 8%, M>F, May change, Responsible for a large number of admissions.

Question 6

What would the medical history of a patient with COPD look like?

Answer 6

• Chronic Cough • Sputum Production • SOB (shortness of breath) • SOBOE (shortness of breath on exercising) • SOBAR (shortness of breath on resting) • Wheeze • Decreased Exercise Tolerance
• Look out for Smoking, as it’s a major risk factor

Question 7

What would a COPD patient look like on inspection?

Answer 7

• Inspection – Accessorymuscles
– Barrelshapedoverinflatedchest
– Decreasedcrico-sternaldistance
– Cyanosis
• Percussion – Hyperresonated Chest, Loss of Liver and Cardiac Dullness
• Auscultation
– QuietBreathsounds,ProlongedExpiration,Wheeze,Rhonci/
Crepitations sometimes audible
• Signs of CO2 Retention
– Bounding Pulse, Warm Peripheries, Flapping Tremor (asterixis), Right Heart Failure (Elevated JVP, Ankle Oedema & Right Ventricular Heave)

Question 8

What’s the pathology of a patient with COPD (as most have chronic bronchitis and emphysema)?

Answer 8

• From chronic bronchitis:
– Narrowing of Airways resulting from inflammation of bronchioles (bronchiolitis) and bronchi with mucosal oedema, mucuous gland hypertrophy, mucous hypersecretion and squamous metaplasia
• From emphysema:
– Destruction and enlargement of the alveoli distal to the terminal bronchioles, typically centriacinar (panacinar in a1antitrypsin).
– Loss of elastic traction that keeps small airways open in expiration.
– Development of emphysematous spaces / bullae if >1cm

Question 9

What are the investigations that can be done?

Answer 9

• Blood – FBC (polycythaemia) –WCC (acute infection)
• CXR – Hyperinflated, flat hemi diaphragms, decreased peripheral lung markings, elongated, cardiac
silhouette
• ECG: – Cor pulmonale
•Sputum / Blood Cultures – Infected exacerbation

Question 10

Arterial Blood Drive (ABG)/ oxygen drive

Answer 10

• Normal Respiration is driven by levels of CO2 • (and not really by oxygen) • A rise in CO2increase in RR • In COPD – this is blunted (depend on hypoxia) • You give Oxygen – they don’t have hypoxia now • Then they stop breathing.
• OPIODS IN THE OPIOD NIAVE

Question 11

How do you manage a patient with COPD?

Answer 11

• Stop Smoking (that’s your job too)
• Bronchodilators (+/- inhaled steroid)
• Oral Theophylline
• Oral Steroids
• Mucolytic Medications
• Treat infective exacerbations (antibiotics/steroids)
• Home/Ambulatory Oxygen

Question 12

What are the complications of COPD?

Answer 12

Acute exacerbation of COPD
Pneumonia
Macro nutrient deficiency 
Wasting, muscle atrophy
Pulmonary hypertension
Right heart failure
Depression
Pneumothorax

Question 13

What’s the prognosis?

Answer 13

Not good.