COPD

Question 1

COPD?

Answer 1

Chronic obstructive lung disorder characterised by airflow obstruction with Chronic bronchitis; Chronic cough and sputum production on most days for at least 3 months per year over 2 consecutive years,

and Emphysema; Pathological diagnosis of permanent destructive enlargement of air spaces distal to the terminal bronchioles.

Bronchial and alveolar damage is caused by environmental toxins.

Question 2

COPD chronic bronchitis?

Answer 2

narrowing of the airways resulting in bronchiole inflammation, bronchial mucosal oedema, mucous hypersectretion, squamous metaplasia.

Question 3

COPD emphasema?

Answer 3

Destruction and enlargement of alveoli, leads to loss of elasticity.

Question 4

COPD epidemiology?

Answer 4

VERY COMMON (8% prevalence)
Presents in middle age or later
More common in males

Question 5

COPD symptoms?

Answer 5

Chronic cough, sputum production, breathlessness, wheeze, reduced exercise tolerance.

Question 6

COPD signs (12)?

Answer 6

Respiratory distress, use of accessory muscles, over-inflated chest, cyanosis, hyper-resonant chest, loss of liver and cardiac dullness, quiet breath sounds, prolonged expiration, wheeze, rhonchi (rattling), bounding pulse, asterixis

Question 7

COPD signs of CO2 retention?

Answer 7

Bounding pulse
Warm peripheries
Asterixis

LATE STAGES: signs of right heart failure (cor pulmonale)

Right ventricular heave Raised JVP
Ankle oedema

Question 8

COPD investigations?

Answer 8

Spirometry and pulmonary function tests (reduced FEV1/FVC, increased lung volumes)

ABG, ECG, sputum.

Question 9

COPD investigations xray?

Answer 9

hyperinflation

Question 10

COPD investigations FBC?

Answer 10

increased Hb and haematocrit due to secondary polycythaemia

Question 11

COPD management?

Answer 11

stop smoking, bronchodilators, steroids, pulmonary rehab, oxygen therapy.

Question 12

COPD management bronchodilators?

Answer 12

Short-acting beta-2 agonists (e.g. salbutamol)

Anticholinergics (e.g. ipratropium bromide)

Long-acting beta-2 agonists (if > 2 exacerbations per year)

Question 13

COPD treatment of acute excaberation?

Answer 13

24% O2 via Venturi mask
Increase slowly if no hypercapnia and still hypoxic (do an ABG) Corticosteroids
Start empirical antibiotic therapy if evidence of infection Respiratory physiotherapy to clear sputum
Non-invasive ventilation may be necessary in severe cases

Question 14

COPD complications (6)?

Answer 14

Acute respiratory failure, infections, pulmonary hypertension, right heart failure, pneumothorax (secondary to bullae rupture), secondary polycythaemia.