Chronic obstructive pulmonary disease

Question 1

What is COPD?

Answer 1

Umbrella term used for chronic bronchitis and emphysema, largely caused by smoking.
Can rarely be caused by alpha-1 antitrypsin deficiency.

Question 2

COPD symptoms

Answer 2

Dry/productive cough
Dyspnoea
Wheeze
Right sided heart failure 
Peripheral oedema
Infective exacerbations

Question 3

COPD investigations and severity

Answer 3

FEV1/FVC < 0.7%.
CXR- hyperinflation, bullae, flat hemidiaphragm, exclude lung cancer.
FBC- secondary polycythaemia
BMI.

FEV1 > 80% Stage 1
FEV1 50-79% Stage 2
FEV1 30-49% Stage 3
FEV1 < 30% Stage 4

Question 4

COPD management

Answer 4

Smoking cessation
One off pneumococcal and yearly flu vaccines.
Pulmonary rehab if > stage 3.

1st line: SABA or SAMA. Salbutamol or ipratropium.

Asthmatic features?
Yes -> 2nd line: LABA e.g. salmeterol + ICS
3rd line: LAMA e.g. tiotropium+ LABA + ICS

No -> 2nd line: SABA+ LABA + LAMA

Consider prophylactic antibiotic therapy with azithromycin in selected patients.

Question 5

COPD- when to give long term oxygen therapy?

Answer 5

In patients with severe airflow obstruction, cyanosis, polycythaemia, peripheral oedema, raised JVP, O2 sats < 92%, no smoking in the home.

Consider risks of falls, burns and fires.

Question 6

COPD- acute exacerbation management

Answer 6

Commonly haemophilus influenzae, strep pneumoniae, moraxella.

Increase frequency of bronchodilators.
Give prednisolone 30mg/ day for 5 days.
Give antibiotics if evidence of pneumonia e.g. amoxicillin/clarithromycin/doxycycline.

Question 7

Alpha 1 antitrypsin deficiency

• Cause
• Symptoms
• Management

Answer 7

Lack of protease inhibitor usually made by the liver. Causes emphysema in young non smokers.
Autosomal dominant condition, found on chromosome 14.

Symptoms of COPD.
At risk of liver cirrhosis and hepatocellular carcinoma. Cholestasis in children.

No smoking, bronchodilators, physio, IV A1AT protein concentrate, surgery.